Provider Demographics
NPI:1679550305
Name:HOLLAND, GEORGE THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:HOLLAND
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 1:11 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-3083
Mailing Address - Country:US
Mailing Address - Phone:910-454-1166
Mailing Address - Fax:910-454-1167
Practice Address - Street 1:924 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3038
Practice Address - Country:US
Practice Address - Phone:910-457-3800
Practice Address - Fax:910-457-7066
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20904OtherCIGNA
NC8943093Medicaid
NC0128732OtherUNITED HEALTHCARE
NC92258OtherMEDCOST
NC9663589OtherGHI
NC0054OtherAETNA
NC080149894OtherRAILROAD ,MEDICARE
NC43093OtherBCBSNC
NC43093OtherBCBSNC
NC8943093Medicaid