MEDICARE: DR. RENEE MYERS HOLLON PHD

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	103TC0700X	Clinical Psychologist	939	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051520056	OTHER	AL	BCBS OF AL

General Provider Information

NPI Number	:	1225087653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE MYERS HOLLON PHD

Provider Business Mailing Address
First Line	:	3200 TAM OSHANTER LN
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-4018
Country	:	US
Telephone Number	:	205-202-0436
Fax Number	:	205-584-4800

Provider Business Practice Location Address
First Line	:	2700 CORPORATE DR STE 200
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-2733
Country	:	US
Telephone Number	:	205-202-0436
Fax Number	:	205-584-4800

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	09/19/2021

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