Healthcare Provider Details

I. General information

NPI: 1912522996
Provider Name (Legal Business Name): ROBERT MICHAEL HEWGLEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 CAPE CENTER DR
FAYETTEVILLE NC
28304-4457
US

IV. Provider business mailing address

PO BOX 187
FAISON NC
28341-0187
US

V. Phone/Fax

Practice location:
  • Phone: 910-354-1720
  • Fax: 910-356-2310
Mailing address:
  • Phone: 910-267-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: