Provider Demographics
NPI:1578243895
Name:HOLLINGSWORTH, COURTNEY ALEXIS
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALEXIS
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 US HIGHWAY 41 N STE 2700
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-3359
Mailing Address - Country:US
Mailing Address - Phone:800-591-0395
Mailing Address - Fax:478-951-3781
Practice Address - Street 1:3421 US HIGHWAY 41 N STE 2700
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-3359
Practice Address - Country:US
Practice Address - Phone:800-591-0395
Practice Address - Fax:478-951-3781
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier