Provider Demographics
NPI:1659321529
Name:HOLLADAY, CLINTON T (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:T
Last Name:HOLLADAY
Suffix:
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 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:701 PRINCETON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1303
Practice Address - Country:US
Practice Address - Phone:205-783-3000
Practice Address - Fax:205-871-4301
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000271962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935488Medicaid
AL009936291Medicaid
AL009936292Medicaid
AL515-33333OtherBLUE CROSS
AL009936293Medicaid
AL515-33331OtherBLUE CROSS
AL511-65663OtherBLUE CROSS
ALP00338341OtherRRMC
AL009935488Medicaid
AL515-33333OtherBLUE CROSS