Provider Demographics
NPI:1093709131
Name:DOBBINS, JACKSON RANDOLPH (PA/C)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:RANDOLPH
Last Name:DOBBINS
Suffix:
Gender:M
Credentials:PA/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RED ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4158
Mailing Address - Country:US
Mailing Address - Phone:781-507-3284
Mailing Address - Fax:
Practice Address - Street 1:3164 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6302
Practice Address - Country:US
Practice Address - Phone:828-669-4505
Practice Address - Fax:828-669-5112
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant