Provider Demographics
NPI:1659346633
Name:HOLMAN, CHARLES MILLIGAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MILLIGAN
Last Name:HOLMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1164
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533-1164
Mailing Address - Country:US
Mailing Address - Phone:228-432-7817
Mailing Address - Fax:228-432-7818
Practice Address - Street 1:147 REYNOIR ST
Practice Address - Street 2:SUITE 306
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4109
Practice Address - Country:US
Practice Address - Phone:228-432-7817
Practice Address - Fax:228-432-7818
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS07743208800000X
GA014510208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016044Medicaid
MSB30382Medicare UPIN