Basic Information
| Provider Information | |||||||||
| NPI: | 1093709131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOBBINS | ||||||||
| FirstName: | JACKSON | ||||||||
| MiddleName: | RANDOLPH | ||||||||
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| Credential: | PA/C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 RED ROBIN WAY | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287524158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815073284 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3164 US HIGHWAY 70 | ||||||||
| Address2: | |||||||||
| City: | BLACK MOUNTAIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287116302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286694505 | ||||||||
| FaxNumber: | 8286695112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 12/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-02013 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.