Healthcare Provider Details

I. General information

NPI: 1952350415
Provider Name (Legal Business Name): JOHN JAY ROBBINS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROOKVIEW HILLS BLVD STE 104
WINSTON SALEM NC
27103-5661
US

IV. Provider business mailing address

3333 BROOKVIEW HILLS BLVD STE 104
WINSTON SALEM NC
27103-5661
US

V. Phone/Fax

Practice location:
  • Phone: 336-760-3007
  • Fax: 336-760-9334
Mailing address:
  • Phone: 336-760-3007
  • Fax: 336-760-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number100313
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: