Provider Demographics
NPI:1790871952
Name:SIKES, GLENN AUSTIN JR (PA)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:AUSTIN
Last Name:SIKES
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NC
Mailing Address - Zip Code:28509-0185
Mailing Address - Country:US
Mailing Address - Phone:252-745-7440
Mailing Address - Fax:
Practice Address - Street 1:1813 S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5210
Practice Address - Country:US
Practice Address - Phone:252-745-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant