Provider Demographics
NPI:1275303729
Name:HOLLAMAN, DEOTIS L
Entity Type:Individual
Prefix:
First Name:DEOTIS
Middle Name:L
Last Name:HOLLAMAN
Suffix:
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 1:823 CEDAR GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2228
Mailing Address - Country:US
Mailing Address - Phone:216-536-7978
Mailing Address - Fax:
Practice Address - Street 1:823 CEDAR GROVE CIR
Practice Address - Street 2:
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-2228
Practice Address - Country:US
Practice Address - Phone:216-536-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health