Provider Demographics
NPI:1588217681
Name:HOLLOWAY, JONATHAN CASEY
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CASEY
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 REGENCY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4251
Mailing Address - Country:US
Mailing Address - Phone:937-561-2497
Mailing Address - Fax:
Practice Address - Street 1:314 REGENCY RIDGE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4251
Practice Address - Country:US
Practice Address - Phone:937-561-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health