Healthcare Provider Details

I. General information

NPI: 1255287025
Provider Name (Legal Business Name): CHASE OLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAGNOLIA ST
GREENSBORO NC
27401-1309
US

IV. Provider business mailing address

475 VINE ST
WINSTON SALEM NC
27101-4135
US

V. Phone/Fax

Practice location:
  • Phone: 336-938-0800
  • Fax: 336-938-0755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-16813
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: