Provider Demographics
NPI:1750163408
Name:HOLLOWAY, JOHNNY DARNELL JR
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:DARNELL
Last Name:HOLLOWAY
Suffix:JR
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 1:4944 WOODMAN PARK DR APT 12
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1161
Mailing Address - Country:US
Mailing Address - Phone:216-583-6303
Mailing Address - Fax:
Practice Address - Street 1:4944 WOODMAN PARK DR APT 12
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-1161
Practice Address - Country:US
Practice Address - Phone:216-583-6303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant