Provider Demographics
NPI:1265932354
Name:HOLLOWELL, JAMISON CARROLL (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:JAMISON
Middle Name:CARROLL
Last Name:HOLLOWELL
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:HILDEBRAN
Mailing Address - State:NC
Mailing Address - Zip Code:28637-8013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 PANTHER TRL SE
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4736
Practice Address - Country:US
Practice Address - Phone:828-758-7376
Practice Address - Fax:828-758-9708
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-36872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLAT-3687OtherLICENSED ATHLETIC TRAINER
2000030544OtherCERTIFIED ATHLETIC TRAINER