1194082479 NPI number — DR. MATTHEW WEBSTER HOLLAR M.D.

Table of content: DR. MATTHEW WEBSTER HOLLAR M.D. (NPI 1194082479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194082479 NPI number — DR. MATTHEW WEBSTER HOLLAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAR
Provider First Name:
MATTHEW
Provider Middle Name:
WEBSTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1194082479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2146 BELCOURT AVE
Provider Second Line Business Mailing Address:
VMG BUSINESS OFFICE
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37212-3504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1485 JESSE JEWELL PKWY NE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30501-3801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-534-1711
Provider Business Practice Location Address Fax Number:
770-534-9158
Provider Enumeration Date:
04/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 076031 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 202I186696 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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