Provider Demographics
NPI:1619958790
Name:HOLLADAY, DAWNETTA JANENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWNETTA
Middle Name:JANENE
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 80883
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0883
Mailing Address - Country:US
Mailing Address - Phone:706-549-8114
Mailing Address - Fax:706-549-0151
Practice Address - Street 1:1620 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6008
Practice Address - Country:US
Practice Address - Phone:706-549-8114
Practice Address - Fax:706-549-0151
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37199207LA0401X
GA037199208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA455887OtherWELLCARE
GA800612OtherBLUE CROSS
GA000572921Medicaid
GA3557650OtherCIGNA
GA990009079OtherRAILROAD MEDICARE
GA123000100OtherUS DEPT OF LABOR W/C
GA123000100OtherUS DEPT OF LABOR W/C
GA800612OtherBLUE CROSS