=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942294681
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL D HOLLAND MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2005
-----------------------------------------------------
Last Update Date | 03/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | EASTERN NEPHROLOGY ASSOCIATES PLLC 2021 NORTH POINT BLVD SUITE 106
-----------------------------------------------------
City | NORTH MYRTLE BEACH
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29582-2224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-663-1401
-----------------------------------------------------
Fax | 910-778-1433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | EASTERN NEPHROLOGY ASSOCIATES PLLC 1302 MEDICAL CENTER DRIVE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-0200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-343-9800
-----------------------------------------------------
Fax | 910-343-8650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 23848
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------