Healthcare Provider Details

I. General information

NPI: 1992790406
Provider Name (Legal Business Name): JANN L HOLWICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 N. FRANKLIN ST.
CHRISTIANSBURG VA
24073
US

IV. Provider business mailing address

668 BEETHOVEN LANE
WILLIAMSBURG WV
24991
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-0677
  • Fax: 309-758-5035
Mailing address:
  • Phone: 304-645-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101048833
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number010148833
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: