Provider Demographics
NPI:1518733625
Name:HOLYFIELD, JAMES COLUMBUS III (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:COLUMBUS
Last Name:HOLYFIELD
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 REDD DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-4574
Mailing Address - Country:US
Mailing Address - Phone:706-832-9293
Mailing Address - Fax:
Practice Address - Street 1:3537 REDD DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-4574
Practice Address - Country:US
Practice Address - Phone:706-832-9293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT013393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist