Provider Demographics
NPI:1811559982
Name:HOLLIS, KEAYMONDA
Entity Type:Individual
Prefix:MR
First Name:KEAYMONDA
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LOBLOLLY LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-7724
Mailing Address - Country:US
Mailing Address - Phone:229-854-8418
Mailing Address - Fax:855-626-0642
Practice Address - Street 1:112 LOBLOLLY LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-7724
Practice Address - Country:US
Practice Address - Phone:229-854-8418
Practice Address - Fax:855-626-0642
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)