Provider Demographics
NPI:1962472936
Name:HOLLADAY, DAVID CARROLL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CARROLL
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:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2728 SUNSET BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4837
Practice Address - Country:US
Practice Address - Phone:803-254-1300
Practice Address - Fax:803-771-7597
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC124804174400000X
SC12480207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE34995Medicare UPIN
SCE349951294Medicare PIN