Provider Demographics
NPI:1790890986
Name:HOLLINGSWORTH, SAMUEL F (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:F
Last Name:HOLLINGSWORTH
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 1:2545 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3433
Mailing Address - Country:US
Mailing Address - Phone:205-221-9790
Mailing Address - Fax:205-221-9982
Practice Address - Street 1:2545 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3433
Practice Address - Country:US
Practice Address - Phone:205-221-9790
Practice Address - Fax:205-221-9982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7436207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51011572OtherBCBS
AL000011572Medicaid
AL51011572OtherBCBS
ALC78953Medicare UPIN
AL3957540001Medicare NSC