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General NPI Number Information
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NPI Number | 1437159118
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Entity Type | Individual
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Provider Name | BOBBY D WITTEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 10188 N MAIN ST
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City | ARCHDALE
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State | NC
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Zip | 27263-2906
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Country | US
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Telephone | 336-802-2070
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Fax | 336-802-2071
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Provider Business Mailing Address
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Address Line | 100 KIMEL FOREST DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6074
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Country | US
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Telephone | 336-716-1331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K9704
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2014-01181
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2014-01181
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License Number State | NC
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