Provider Demographics
NPI:1003355140
Name:HOLLOMAN, JUDY B
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:B
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9161 HIGHWAY 29 S
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:GA
Mailing Address - Zip Code:30646-3772
Mailing Address - Country:US
Mailing Address - Phone:706-613-1734
Mailing Address - Fax:706-613-1909
Practice Address - Street 1:9161 HIGHWAY 29 S
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:GA
Practice Address - Zip Code:30646-3772
Practice Address - Country:US
Practice Address - Phone:706-613-1734
Practice Address - Fax:706-613-1909
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist