Provider Demographics
NPI:1639286412
Name:HOLLAND, JOHN CHADLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHADLEY
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:794 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-4074
Practice Address - Country:US
Practice Address - Phone:336-904-2317
Practice Address - Fax:336-443-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401636207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900296Medicaid
NC13836OtherBCBS
NC13836OtherBCBS
NC5900296Medicaid