Provider Demographics
NPI:1225121346
Name:HOLLENSWORTH, BRIAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:HOLLENSWORTH
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 1:1720 SPRINGHILL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1410
Mailing Address - Country:US
Mailing Address - Phone:251-435-1200
Mailing Address - Fax:251-435-6357
Practice Address - Street 1:1720 SPRINGHILL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1410
Practice Address - Country:US
Practice Address - Phone:251-435-1200
Practice Address - Fax:251-435-6357
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL273602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I130015OtherMEDICARE PTAN