Provider Demographics
NPI:1083802557
Name:HUGHES, COURTNEY SAMS (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SAMS
Last Name:HUGHES
Suffix:
Gender:F
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 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-0800
Mailing Address - Fax:336-718-0871
Practice Address - Street 1:100 ROBINHOOD MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5472
Practice Address - Country:US
Practice Address - Phone:336-718-0800
Practice Address - Fax:336-718-0871
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1077356OtherNCCPA
NC8101864Medicaid
NC2759004BMedicare PIN
NC2759004AMedicare PIN
1077356OtherNCCPA
NC8101864Medicaid