Provider Demographics
NPI:1477344240
Name:HOLLIWAY, JERMEKKIO MARQUAIZ
Entity type:Individual
Prefix:
First Name:JERMEKKIO
Middle Name:MARQUAIZ
Last Name:HOLLIWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3382 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2607
Mailing Address - Country:US
Mailing Address - Phone:771-201-6342
Mailing Address - Fax:
Practice Address - Street 1:1911 T ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4636
Practice Address - Country:US
Practice Address - Phone:771-217-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant