Healthcare Provider Details

I. General information

NPI: 1346246022
Provider Name (Legal Business Name): JOHN HOLLINGSWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101A YORK CROSSING RD
GRAFTON VA
23692-2737
US

IV. Provider business mailing address

860 OMNI BLVD SUITE 303
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-898-7737
  • Fax: 757-898-8377
Mailing address:
  • Phone: 757-232-8777
  • Fax: 757-232-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101045245
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: