Provider Demographics
NPI:1508843772
Name:SUMMERLIN, HOLLY G (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:G
Last Name:SUMMERLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4507 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5336
Mailing Address - Country:US
Mailing Address - Phone:228-762-8132
Mailing Address - Fax:228-769-9231
Practice Address - Street 1:4507 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5336
Practice Address - Country:US
Practice Address - Phone:228-762-8132
Practice Address - Fax:228-769-9231
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS18604207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08826864Medicaid
MSI-18622Medicare UPIN
MS160000651Medicare ID - Type UnspecifiedPHYSICIAN