Provider Demographics
NPI:1518692342
Name:HOLLY SPRINGS FAMILY MEDICAL LLC
Entity Type:Organization
Organization Name:HOLLY SPRINGS FAMILY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:662-274-3212
Mailing Address - Street 1:130 W VAN DORN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-2902
Mailing Address - Country:US
Mailing Address - Phone:662-274-3212
Mailing Address - Fax:662-274-3213
Practice Address - Street 1:130 W VAN DORN AVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-2902
Practice Address - Country:US
Practice Address - Phone:662-274-3212
Practice Address - Fax:662-274-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-17
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty