Individual
JIM SISTASIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
147 E ACADEMY ST, ASHEBORO, NC 27203-5706
(336) 633-1212
(336) 633-1218
Mailing address
PO BOX 4247, ASHEBORO, NC 27204-4247
(336) 633-1212
(336) 633-1218
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9901476
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89131HV
—
NC
Enumeration date
11/29/2005
Last updated
10/07/2011
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