Healthcare Provider Details

I. General information

NPI: 1376630293
Provider Name (Legal Business Name): ROBERT JOHN HOLLOWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MOUNTAIN DR
DAHLONEGA GA
30533-1606
US

IV. Provider business mailing address

PO BOX 658
GAINESVILLE GA
30503-0658
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-7078
  • Fax: 770-219-7365
Mailing address:
  • Phone: 770-718-1122
  • Fax: 770-535-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number243140-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2026008581
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number031263
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31263
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: