Provider Demographics
NPI:1144533456
Name:ROBBIE WILSON COMMUNITITY SERVICES
Entity type:Organization
Organization Name:ROBBIE WILSON COMMUNITITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EYVETTE
Authorized Official - Middle Name:LACHELLE
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-473-9933
Mailing Address - Street 1:3533 N GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-3824
Mailing Address - Country:US
Mailing Address - Phone:336-473-9933
Mailing Address - Fax:
Practice Address - Street 1:1001 S MARSHALL ST STE 53
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5858
Practice Address - Country:US
Practice Address - Phone:336-473-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D2008287291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory