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General NPI Number Information
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NPI Number | 1811046089
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Entity Type | Organization
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Legal Business Name | MARSHA JORDAN HOLLOWAY, LLC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2547 LAFAYETTE PLAZA DR
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City | ALBANY
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State | GA
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Zip | 31707-2200
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Country | US
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Telephone | 229-438-8228
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Fax | 229-438-0543
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Provider Business Mailing Address
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Address Line | 2547 LAFAYETTE PLAZA DR
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City | ALBANY
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State | GA
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Zip | 31707-2200
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Country | US
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Telephone | 229-438-8228
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Fax | 229-438-0543
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | AMANDA COOPER
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Credential |
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Telephone | 229-386-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 010688
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License Number State | GA
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