Provider Demographics
NPI:1326067737
Name:HOLLIDAY, JAMES N (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4571 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4135
Mailing Address - Country:US
Mailing Address - Phone:901-680-0043
Mailing Address - Fax:901-680-8030
Practice Address - Street 1:4571 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4135
Practice Address - Country:US
Practice Address - Phone:901-680-0043
Practice Address - Fax:901-680-8030
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18644207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3034497Medicaid
TN0840082OtherUNITED HEALTHCARE ID
TN3037111OtherBCBS PROVIDER ID
TN3034497Medicaid
TN3034497Medicare ID - Type Unspecified
TN3034497Medicaid