Provider Demographics
NPI:1225406366
Name:HOLIDAY, ANDREW III
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:HOLIDAY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 CORMAC DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-7195
Mailing Address - Country:US
Mailing Address - Phone:860-478-7052
Mailing Address - Fax:
Practice Address - Street 1:5436 RIVERDALE RD STE 115
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-6100
Practice Address - Country:US
Practice Address - Phone:860-478-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-06
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral