Healthcare Provider Details

I. General information

NPI: 1982751509
Provider Name (Legal Business Name): ELIZABETH M HOLLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 ST. VINCENTS DR. STE 401
BHAM AL
35205
US

IV. Provider business mailing address

1830 14TH AVENUE SOUTH
BHAM AL
35205
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-2250
  • Fax: 205-933-2221
Mailing address:
  • Phone: 205-933-2250
  • Fax: 205-933-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.026739
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number28892
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: