Provider Demographics
NPI:1881679488
Name:HOLLADAY, RODNEY L (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:L
Last Name:HOLLADAY
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 1:165 WHITESPORT DR SW STE 3
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7427
Mailing Address - Country:US
Mailing Address - Phone:256-429-4956
Mailing Address - Fax:256-429-7643
Practice Address - Street 1:165 DRIVE WHITESPORT DRIVE
Practice Address - Street 2:STE 3
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-429-4956
Practice Address - Fax:256-429-7643
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14386207RG0300X
TN14386208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3003722Medicaid
MS00112325Medicaid
MS00112325Medicaid
TN3003722Medicaid
TN30037201Medicare PIN