Healthcare Provider Details

I. General information

NPI: 1548269442
Provider Name (Legal Business Name): HILDEGARD H HOLMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROBERTSON BLVD
WALTERBORO SC
29488-2787
US

IV. Provider business mailing address

4615 OLEANDER DR
MYRTLE BEACH SC
29577-5741
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-5929
  • Fax: 843-497-9940
Mailing address:
  • Phone: 843-497-5929
  • Fax: 843-497-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19119
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: