MEDICARE: DR. BASIL B HOLOYDA M.D.

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	2084N0400X	Neurology Physician	57180	GA
2	2084N0400X	Neurology Physician	01099036A	IN

General Provider Information

NPI Number	:	1093753451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASIL B HOLOYDA M.D.

Provider Business Mailing Address
First Line	:	389 MULBERRY ST
Second Line	:	SUITE 200
City	:	MACON
State	:	GA
Zip	:	31201-7914
Country	:	US
Telephone Number	:	478-743-9123
Fax Number	:	478-742-9809

Provider Business Practice Location Address
First Line	:	2451 INTELLIPLEX DR
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8580
Country	:	US
Telephone Number	:	317-392-3211
Fax Number	:

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	02/16/2026

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