Healthcare Provider Details

I. General information

NPI: 1427816172
Provider Name (Legal Business Name): CRISTY HOLLOMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 DAWSONVILLE HWY STE A
GAINESVILLE GA
30501-2615
US

IV. Provider business mailing address

956 DAWSONVILLE HWY STE A
GAINESVILLE GA
30501-2615
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-5552
  • Fax:
Mailing address:
  • Phone: 770-536-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001123
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: