Provider Demographics
NPI:1164406922
Name:HOLLINGSWORTH, ROBERT LEE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:L
Other - Last Name:HOLLINGSWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2170 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2999
Mailing Address - Country:US
Mailing Address - Phone:910-295-2100
Mailing Address - Fax:910-295-3625
Practice Address - Street 1:2170 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2999
Practice Address - Country:US
Practice Address - Phone:910-295-2100
Practice Address - Fax:910-295-3625
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100599363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101220Medicaid
NC2748542DMedicare PIN