Healthcare Provider Details

I. General information

NPI: 1447570452
Provider Name (Legal Business Name): HOLLY H ZIMMERMAN M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST DIVISION OF MEDICAL GENETICS
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST DIVISION OF MEDICAL GENETICS
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-4490
  • Fax: 601-984-1916
Mailing address:
  • Phone: 601-815-4490
  • Fax: 601-984-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: