Provider Demographics
NPI:1508120684
Name:PETER O. HOLLIDAY, III M.D. P.C.
Entity Type:Organization
Organization Name:PETER O. HOLLIDAY, III M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:O
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:478-474-0394
Mailing Address - Street 1:420 CHARTER BLVD
Mailing Address - Street 2:STE 402
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4854
Mailing Address - Country:US
Mailing Address - Phone:478-474-0394
Mailing Address - Fax:478-477-5509
Practice Address - Street 1:420 CHARTER BLVD
Practice Address - Street 2:STE 402
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4854
Practice Address - Country:US
Practice Address - Phone:478-474-0394
Practice Address - Fax:478-477-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G704949Medicare PIN