Healthcare Provider Details

I. General information

NPI: 1366702524
Provider Name (Legal Business Name): CODY M HOLLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CONTINENTAL PL SUITE 405
BRENTWOOD TN
37027-1041
US

IV. Provider business mailing address

103 CONTINENTAL PL SUITE 405
BRENTWOOD TN
37027-1041
US

V. Phone/Fax

Practice location:
  • Phone: 877-977-4630
  • Fax: 888-242-7469
Mailing address:
  • Phone: 877-977-4630
  • Fax: 888-242-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: