Healthcare Provider Details

I. General information

NPI: 1467443424
Provider Name (Legal Business Name): DAVID ALAN HOLLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 J C MAULDIN HIGHWAY
KILLEN AL
35645
US

IV. Provider business mailing address

PO BOX 309 148 J C MAULDIN HIGHWAY
KILLEN AL
35645-0309
US

V. Phone/Fax

Practice location:
  • Phone: 256-757-5353
  • Fax: 256-757-9744
Mailing address:
  • Phone: 256-757-5353
  • Fax: 256-757-9744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11228
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: