Provider Demographics
NPI:1609083807
Name:HOLLIS, ALICIA GRACE (DO)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:GRACE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2660 ELECTRIC RD STE C&D
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3532
Mailing Address - Country:US
Mailing Address - Phone:540-556-1061
Mailing Address - Fax:540-208-0922
Practice Address - Street 1:2660 ELECTRIC RD STE C&D
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3532
Practice Address - Country:US
Practice Address - Phone:540-556-1061
Practice Address - Fax:540-208-0922
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005271207R00000X
VA0102202320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine