Provider Demographics
NPI:1073555959
Name:VOLLMER, JOHN J (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:VOLLMER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:3510 HIGHWAY 17 BYP N STE 105
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8228
Practice Address - Country:US
Practice Address - Phone:843-789-8250
Practice Address - Fax:843-724-2551
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2553363AS0400X, 363AS0400X
VA0110001002363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2730PAMedicaid
VA540885859OtherCOMPMANAGEMENT
VA540885859OtherFIRST HEALTH/CCN
VA65456OtherANTHEM HEALTHKEEPERS
VA91486POtherOPTIMA HEALTH
VA0539484OtherAETNA HMO
SC2730PAMedicaid
VA540885859OtherC&O EMPLOYEE'S HEALTHCARE
VA540885859OtherCIGNA
VA540885859OtherFOCUS
VA31572OtherSH CARENET
VA540885859OtherCORVEL
VA970014485OtherRAILROAD MEDICARE
VA285563OtherSOUTHERN HEALTH
VA540885859OtherPRIVATE HEALTHCARE SYSTEM
VA540885859OtherCORVEL
VA0539484OtherAETNA HMO
SC2730PAMedicaid