Provider Demographics
NPI:1750569737
Name:SAMUEL HOLLINSWORTH MD PC
Entity type:Organization
Organization Name:SAMUEL HOLLINSWORTH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-221-9790
Mailing Address - Street 1:2545 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3433
Mailing Address - Country:US
Mailing Address - Phone:205-221-9790
Mailing Address - Fax:205-221-9982
Practice Address - Street 1:2545 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3433
Practice Address - Country:US
Practice Address - Phone:205-221-9790
Practice Address - Fax:205-221-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
3957540001Medicare NSC