Provider Demographics
NPI:1700988102
Name:HOLIFIELD, CYNTHIA J VI
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:HOLIFIELD
Suffix:VI
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HWY 80 EAST
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732
Mailing Address - Country:US
Mailing Address - Phone:334-289-2242
Mailing Address - Fax:334-289-2241
Practice Address - Street 1:915 HWY 80 EAST
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732
Practice Address - Country:US
Practice Address - Phone:334-289-2242
Practice Address - Fax:334-289-2241
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL627332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-41261OtherBLUE CROSS BLUE SHIELD
AL515-41261OtherBLUE CROSS BLUE SHIELD