Provider Demographics
NPI:1023294006
Name:HOLLISTER, JOHN CAMERON JR (LAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CAMERON
Last Name:HOLLISTER
Suffix:JR
Gender:M
Credentials:LAC
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Mailing Address - Street 1:2285 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1142
Mailing Address - Country:US
Mailing Address - Phone:404-250-2055
Mailing Address - Fax:
Practice Address - Street 1:2285 PEACHTREE RD NE
Practice Address - Street 2:SUITE 202
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1142
Practice Address - Country:US
Practice Address - Phone:404-250-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist