Healthcare Provider Details

I. General information

NPI: 1992639009
Provider Name (Legal Business Name): BOBBY JACOB BIGGERSTAFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 OLD STILL DR
MARION NC
28752-5971
US

IV. Provider business mailing address

44 OLD STILL DR
MARION NC
28752-5971
US

V. Phone/Fax

Practice location:
  • Phone: 843-270-5353
  • Fax: 843-270-5353
Mailing address:
  • Phone: 843-270-5353
  • Fax: 843-270-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: