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General NPI Number Information
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NPI Number | 1871099499
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Entity Type | Individual
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Provider Name | BLAKE RYAN HOLLOWOA MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 9228 MEDICAL PLAZA DR
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City | CHARLESTON
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State | SC
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Zip | 29406-9125
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Country | US
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Telephone | 843-574-5693
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Fax | 843-764-4512
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Provider Business Mailing Address
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Address Line | 335 24TH AVE N
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City | NASHVILLE
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State | TN
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Zip | 37203-1503
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Country | US
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Telephone | 615-342-0290
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Fax | 615-342-0289
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 89309
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 71712
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License Number State | TN
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