Provider Demographics
NPI:1043269327
Name:JOLLEY, ROBERT BEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BEN
Last Name:JOLLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:BEN
Other - Last Name:JOLLEY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1009 MUDDY FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-7833
Mailing Address - Country:US
Mailing Address - Phone:803-920-3754
Mailing Address - Fax:
Practice Address - Street 1:NORTON COMMUNITY HOSPITAL
Practice Address - Street 2:100 15TH ST NW
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273
Practice Address - Country:US
Practice Address - Phone:276-439-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN62415207P00000X, 207Q00000X
SC12868207P00000X, 207Q00000X
VA0101273347207Q00000X, 207P00000X
NC306386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC128686Medicaid
P00237190OtherRRGA
SC128686Medicaid
SCB920728165Medicare Oscar/Certification