Provider Demographics
NPI:1013985845
Name:HOLLAND, JOYCELYN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:RENEE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARKET SQ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5613
Mailing Address - Country:US
Mailing Address - Phone:770-252-3783
Mailing Address - Fax:770-252-4918
Practice Address - Street 1:10 MARKET SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5613
Practice Address - Country:US
Practice Address - Phone:770-252-3783
Practice Address - Fax:770-252-4918
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0406914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000742585EMedicaid
G54498Medicare UPIN
GA000742585EMedicaid