Provider Demographics
NPI:1700118379
Name:MCDONALD, HOLLIS JR (HAD)
Entity Type:Individual
Prefix:MR
First Name:HOLLIS
Middle Name:
Last Name:MCDONALD
Suffix:JR
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E. SUNSET ROAD
Mailing Address - Street 2:UNIT 96595
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-1246
Mailing Address - Country:US
Mailing Address - Phone:702-798-0113
Mailing Address - Fax:866-291-5242
Practice Address - Street 1:100 EDSEL DR
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3980
Practice Address - Country:US
Practice Address - Phone:912-339-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000557237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist