Healthcare Provider Details

I. General information

NPI: 1417767088
Provider Name (Legal Business Name): ELIZABETH COMBS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ROCKFORD ST
MOUNT AIRY NC
27030-5322
US

IV. Provider business mailing address

PO BOX 1267
MOUNT AIRY NC
27030-1267
US

V. Phone/Fax

Practice location:
  • Phone: 336-783-8374
  • Fax: 336-786-4048
Mailing address:
  • Phone: 336-719-7112
  • Fax: 336-786-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: