1538623202 NPI number — MR. JAMES ROBERT HOLLAND III

Table of content: MR. JAMES ROBERT HOLLAND III (NPI 1538623202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538623202 NPI number — MR. JAMES ROBERT HOLLAND III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
JAMES
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
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:
1538623202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 ASPEN HEIGHTS LN APT 711
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36830-4061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-783-1773
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2316 WALKER BUILDING
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN UNIVERSITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36849-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-783-1773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2019

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 , with the licence number:  S12468 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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