Glen Edward Combs, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

101309 Issued in NC

Practice address

2255 Lewisville Clemmons Rd
Clemmons, NC 27012-7463

Phone

(336) 766-0505

NPI assigned

Feb 9, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1235102211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 BURKEWOOD DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043945",
            "telephone_number": "336-970-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 LEWISVILLE CLEMMONS RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127463",
            "telephone_number": "336-766-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COMBS",
        "first_name": "GLEN",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "101309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009241E25",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS/TRICARE",
            "identifier": "-010",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD LICENSE",
            "identifier": "101309",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clemmons Village I LLC (Clemmons Village I)
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• Phyllis Patricia Coconis, NP
• Mary Ann Coffey, R.PH
• Rachel Anne Bostic Collins
• Complete Rehab
• Cornerstone Health Care PA (Mothershed Mothershed Arne Cates & Cane)
• Dylan William Cortese, BS, MSPAS, PA-C
• Marina Coutros, RBT
• Jason Malcolm Crandell, M.D.

• Physician Assistant in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.