Healthcare Provider Details

I. General information

NPI: 1831162437
Provider Name (Legal Business Name): MICHAEL HOLLIFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/05/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 MOUNTAIN CITY RD
CLAYTON GA
30525-3072
US

IV. Provider business mailing address

PO BOX 2442
COLUMBUS GA
31902-2442
US

V. Phone/Fax

Practice location:
  • Phone: 706-960-9533
  • Fax: 706-782-0465
Mailing address:
  • Phone: 706-960-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number032206
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number032206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: