Provider Demographics
NPI:1447617147
Name:POUNCEY, HOLLAND SPORT (PA)
Entity Type:Individual
Prefix:
First Name:HOLLAND
Middle Name:SPORT
Last Name:POUNCEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-7306
Mailing Address - Country:US
Mailing Address - Phone:334-335-3383
Mailing Address - Fax:334-335-3078
Practice Address - Street 1:1704 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7306
Practice Address - Country:US
Practice Address - Phone:334-335-3383
Practice Address - Fax:334-335-3078
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-1115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant