Healthcare Provider Details

I. General information

NPI: 1871794412
Provider Name (Legal Business Name): DON HOLLINGSWORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 COURT ST SUITE 106
JACKSON CA
95642-2160
US

IV. Provider business mailing address

601 COURT ST SUITE 106
JACKSON CA
95642-2160
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-0686
  • Fax: 209-257-0197
Mailing address:
  • Phone: 209-257-0686
  • Fax: 209-257-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DON BUTCH HOLLINGSWORTH
Title or Position: OWNER
Credential:
Phone: 209-257-0686