Healthcare Provider Details

I. General information

NPI: 1184674962
Provider Name (Legal Business Name): MICHAEL G HOLLOMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MAPLE SUITE 403
SPRINGDALE AR
72764-5374
US

IV. Provider business mailing address

601 WEST MAPLE SUITE 403
SPRINGDALE AR
72764-5374
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-2742
  • Fax: 479-750-2742
Mailing address:
  • Phone: 479-750-2742
  • Fax: 479-750-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR2597
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: