NPI Code Detail JSON Logo

1609083807 NPI number — ALICIA GRACE HOLLIS DO

NPI Number: 1609083807
Health Care Provider/Practitioner: ALICIA GRACE HOLLIS DO

Information about “1609083807” NPI (ALICIA GRACE HOLLIS DO) exists in 1609083807 in HTML format HTML  |  1609083807 in plain Text format TXT  |  1609083807 in PDF (Portable Document Format) PDF  |  1609083807 in an XML format XML  formats.

NPI Number : 1609083807 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609083807",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLLIS",
    "FirstName": "ALICIA",
    "MiddleName": "GRACE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2660 ELECTRIC RD STE C&D",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROANOKE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "24018-3532",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "540-556-1061",
    "MailingAddressFaxNumber": "540-208-0922",
    "FirstLinePracticeLocationAddress": "2660 ELECTRIC RD STE C&D",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROANOKE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "24018-3532",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "540-556-1061",
    "PracticeLocationAddressFaxNumber": "540-208-0922",
    "EnumerationDate": "05/17/2007",
    "LastUpdateDate": "12/30/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "005271",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "0102202320",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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