Provider Demographics
NPI:1952342586
Name:HOLLEY, JOSEPH EUGENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EUGENE
Last Name:HOLLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40434
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-0434
Mailing Address - Country:US
Mailing Address - Phone:901-493-5374
Mailing Address - Fax:
Practice Address - Street 1:275 ISLAND VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-9028
Practice Address - Country:US
Practice Address - Phone:901-493-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19758207P00000X
MS11045207P00000X, 208D00000X
TN019758208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154941002Medicaid
TN4081932OtherBLUE CROSS
MS00017398Medicaid
TN3046356Medicaid
MS00017398Medicaid
TN3046356Medicaid
TN3046357Medicare PIN
TNP00293653Medicare ID - Type UnspecifiedMEDICARE RAILROAD