Healthcare Provider Details

I. General information

NPI: 1528028875
Provider Name (Legal Business Name): MR. JOHN HOLCOMBE HOLLOWAY III
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JOHN H HOLLOWAY MD

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PAYNE RD AMERICAN FAMILY CARE INC
GARDENDALE AL
35071
US

IV. Provider business mailing address

2147 RIVERCHASE OFFICE RD
BIRMINGHAM AL
35244-1836
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-6834
  • Fax: 205-631-0273
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-982-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6733
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: