Healthcare Provider Details

I. General information

NPI: 1427286293
Provider Name (Legal Business Name): AARON S HOLLY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 RUIN CREEK RD
HENDERSON NC
27536-2927
US

IV. Provider business mailing address

3114 CROASDAILE DR SUITE 200
DURHAM NC
27705-2508
US

V. Phone/Fax

Practice location:
  • Phone: 919-425-1565
  • Fax: 919-425-0478
Mailing address:
  • Phone: 919-425-1565
  • Fax: 919-425-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102971
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: