MEDICARE: MR. JOHN CAMERON HOLLISTER JR. L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	64	GA

General Provider Information

NPI Number	:	1023294006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CAMERON HOLLISTER JR. L.AC.

Provider Business Mailing Address
First Line	:	2285 PEACHTREE RD NE
Second Line	:	SUITE 202
City	:	ATLANTA
State	:	GA
Zip	:	30309-1142
Country	:	US
Telephone Number	:	404-250-2055
Fax Number	:

Provider Business Practice Location Address
First Line	:	2285 PEACHTREE RD NE
Second Line	:	SUITE 202
City	:	ATLANTA
State	:	GA
Zip	:	30309-1142
Country	:	US
Telephone Number	:	404-250-2055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	01/21/2008

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