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NPI Code Detail

MEDICARE: CHARLES JACKSON HOLLAND M.D.

MEDICARE: CHARLES JACKSON HOLLAND 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
1207X00000XOrthopaedic Surgery PhysicianME12310FL

General Provider Information

NPI Number : 1093961666
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES JACKSON HOLLAND M.D.
Provider Business Mailing Address
First Line : 405 PIEDMONT DRIVE
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32312-2323
Country : US
Telephone Number : 850-385-0320
Fax Number :
Provider Business Practice Location Address
First Line : 2390 PHILLIPS ROAD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-5326
Country : US
Telephone Number : 850-487-2604
Fax Number : 850-922-2123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2008
Last Update Date : 08/14/2008

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Directions to “ CHARLES JACKSON HOLLAND M.D.” Practice Location

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