Provider Demographics
NPI:1851494462
Name:HOLLEY, JERRY MORGAN (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:MORGAN
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6570 SUMMER OAKS COVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134
Mailing Address - Country:US
Mailing Address - Phone:901-373-7100
Mailing Address - Fax:901-842-0020
Practice Address - Street 1:6570 SUMMER OAKS COVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134
Practice Address - Country:US
Practice Address - Phone:901-373-7100
Practice Address - Fax:901-842-0020
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11366207R00000X
TN20391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E81386Medicare UPIN
TN3057215Medicare PIN