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NPI Code Detail

MEDICARE: JUSTIN PIKE OLLIS PA-C

MEDICARE: JUSTIN PIKE OLLIS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-06348NC

General Provider Information

NPI Number : 1932207701
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN PIKE OLLIS PA-C
Provider Business Mailing Address
First Line : 100 KIMEL FOREST DR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-6074
Country : US
Telephone Number : 336-716-2255
Fax Number :
Provider Business Practice Location Address
First Line : 3200 NORTHLINE AVE
Second Line : SUITE 200
City : GREENSBORO
State : NC
Zip : 27408-7602
Country : US
Telephone Number : 336-545-5000
Fax Number : 336-545-5020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 02/27/2026

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Directions to “ JUSTIN PIKE OLLIS PA-C” Practice Location

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