Provider Demographics
NPI:1093961666
Name:HOLLAND, CHARLES JACKSON (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JACKSON
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PIEDMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-2323
Mailing Address - Country:US
Mailing Address - Phone:850-385-0320
Mailing Address - Fax:
Practice Address - Street 1:2390 PHILLIPS ROAD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5326
Practice Address - Country:US
Practice Address - Phone:850-487-2604
Practice Address - Fax:850-922-2123
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12310207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery