Provider Demographics
NPI:1649237900
Name:HOLLAND,, EVANS P JR (MD)
Entity Type:Individual
Prefix:
First Name:EVANS
Middle Name:P
Last Name:HOLLAND,
Suffix:JR
Gender:M
Credentials:MD
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-667-1891
Mailing Address - Fax:843-665-2516
Practice Address - Street 1:101 WILLIAM H. JOHNSON STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-667-1891
Practice Address - Fax:843-665-2516
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19407207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790568VMedicaid
SCT33577Medicaid
SCT33577Medicaid
G24764Medicare UPIN