Healthcare Provider Details

I. General information

NPI: 1023294006
Provider Name (Legal Business Name): JOHN CAMERON HOLLISTER JR. L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 PEACHTREE RD NE SUITE 202
ATLANTA GA
30309-1142
US

IV. Provider business mailing address

2285 PEACHTREE RD NE SUITE 202
ATLANTA GA
30309-1142
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-2055
  • Fax:
Mailing address:
  • Phone: 404-250-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number64
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: