Healthcare Provider Details

I. General information

NPI: 1659321529
Provider Name (Legal Business Name): CLINTON T HOLLADAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PRINCETON AVE SW
BIRMINGHAM AL
35211-1303
US

IV. Provider business mailing address

2000A SOUTHBRIDGE PKWY STE 300
BIRMINGHAM AL
35209-7718
US

V. Phone/Fax

Practice location:
  • Phone: 205-783-3000
  • Fax: 205-871-4301
Mailing address:
  • Phone: 205-871-4274
  • Fax: 205-871-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number00027196
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: