Provider Demographics
NPI:1437227741
Name:HOLLEMAN, JANE BLUE (PT, MPH)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:BLUE
Last Name:HOLLEMAN
Suffix:
Gender:F
Credentials:PT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 1025
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1025
Mailing Address - Country:US
Mailing Address - Phone:478-275-1740
Mailing Address - Fax:478-272-7006
Practice Address - Street 1:612 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-0112
Practice Address - Country:US
Practice Address - Phone:478-275-1740
Practice Address - Fax:478-272-7006
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00552351DMedicaid
GA65BBBBZMedicare ID - Type Unspecified