Provider Demographics
NPI:1891552907
Name:JOLLY, P.C.
Entity Type:Organization
Organization Name:JOLLY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANTLEY
Authorized Official - Middle Name:TILMAN
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-422-3855
Mailing Address - Street 1:823 CONGRESS AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2402
Mailing Address - Country:US
Mailing Address - Phone:888-813-0218
Mailing Address - Fax:
Practice Address - Street 1:823 CONGRESS AVE STE 1200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2402
Practice Address - Country:US
Practice Address - Phone:888-813-0218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty