Provider Demographics
NPI:1265625446
Name:ZACHARY, HOLLY R (MEDCCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:R
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:MEDCCC-SLP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:R
Other - Last Name:ZACHARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDCCC-SLP
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-1005
Mailing Address - Country:US
Mailing Address - Phone:912-375-2009
Mailing Address - Fax:912-379-0081
Practice Address - Street 1:147 S TALLAHASSEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6466
Practice Address - Country:US
Practice Address - Phone:912-375-2009
Practice Address - Fax:912-379-0081
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist