1053663310 NPI number — H DOUGLAS HOLLIDAY MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053663310 NPI number — H DOUGLAS HOLLIDAY MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H DOUGLAS HOLLIDAY MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053663310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2912 POLO CLUB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37221-4343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-584-9914
Provider Business Mailing Address Fax Number:
615-222-1245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4230 HARDING PIKE
Provider Second Line Business Practice Location Address:
SUITE 530
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-222-1241
Provider Business Practice Location Address Fax Number:
615-222-1245
Provider Enumeration Date:
10/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLIDAY
Authorized Official First Name:
HUGH
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
615-584-9914

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  10586 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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