Provider Demographics
NPI:1770620098
Name:JEFFREY N HOLLEY MD PC
Entity type:Organization
Organization Name:JEFFREY N HOLLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-524-2232
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-0637
Mailing Address - Country:US
Mailing Address - Phone:229-524-2232
Mailing Address - Fax:229-524-8766
Practice Address - Street 1:214 CHERRY ST
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1616
Practice Address - Country:US
Practice Address - Phone:229-524-2232
Practice Address - Fax:229-524-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038013173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF85716Medicare UPIN
GAGRP6806Medicare ID - Type Unspecified