Provider Demographics
NPI:1942244736
Name:HOLLINGSWORTH, JERRY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:MICHAEL
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:867 LEE RD 248
Mailing Address - Street 2:PO BOX 1417
Mailing Address - City:SMITHS
Mailing Address - State:AL
Mailing Address - Zip Code:36877
Mailing Address - Country:US
Mailing Address - Phone:334-291-8400
Mailing Address - Fax:334-291-8409
Practice Address - Street 1:867 LEE RD. 248
Practice Address - Street 2:
Practice Address - City:SMITHS
Practice Address - State:AL
Practice Address - Zip Code:36877
Practice Address - Country:US
Practice Address - Phone:334-291-8400
Practice Address - Fax:334-291-8409
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALD0497207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1223358OtherCIGNA
AL1223358OtherCIGNA
GA08BBXFJMedicare ID - Type Unspecified