Provider Demographics
NPI:1760666291
Name:JOLLY, BOBBY LYNN (ADMINISTRATOR)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:LYNN
Last Name:JOLLY
Suffix:
Gender:
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-9059
Mailing Address - Country:US
Mailing Address - Phone:828-390-3970
Mailing Address - Fax:828-391-1207
Practice Address - Street 1:5816 WILLOW POINT DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-8602
Practice Address - Country:US
Practice Address - Phone:828-390-4370
Practice Address - Fax:828-391-1207
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker