Provider Demographics
NPI:1972593028
Name:HOLLADAY, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:HOLLADAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 934925
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-4925
Mailing Address - Country:US
Mailing Address - Phone:404-501-6925
Mailing Address - Fax:404-501-6930
Practice Address - Street 1:2675 N DECATUR RD STE G09
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6130
Practice Address - Country:US
Practice Address - Phone:404-501-6925
Practice Address - Fax:404-501-6930
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0333562085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE91364Medicare UPIN
GA511I920001OtherMEDICARE PTAN
GAE91364Medicare UPIN
GA718970304FMedicaid