Healthcare Provider Details

I. General information

NPI: 1982451688
Provider Name (Legal Business Name): MARY BATES WORBINGTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH BATES

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 TALLULAH RD
ROBBINSVILLE NC
28771-8500
US

IV. Provider business mailing address

46 SAM HILL RD
ROBBINSVILLE NC
28771-8210
US

V. Phone/Fax

Practice location:
  • Phone: 828-479-6434
  • Fax:
Mailing address:
  • Phone: 601-470-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14199
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0010-14199
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: