Provider Demographics
NPI:1790444016
Name:HOLLEY, GREGORY DERRELL JR (MS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DERRELL
Last Name:HOLLEY
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-2901
Mailing Address - Country:US
Mailing Address - Phone:615-268-9241
Mailing Address - Fax:
Practice Address - Street 1:301 S PERIMETER PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4128
Practice Address - Country:US
Practice Address - Phone:810-529-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health