Healthcare Provider Details

I. General information

NPI: 1679550305
Provider Name (Legal Business Name): GEORGE THOMAS HOLLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N HOWE ST
SOUTHPORT NC
28461-3038
US

IV. Provider business mailing address

PO BOX 96860
CHARLOTTE NC
28296-6860
US

V. Phone/Fax

Practice location:
  • Phone: 910-457-3800
  • Fax: 910-457-7066
Mailing address:
  • Phone: 910-754-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39512
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: