MEDICARE: HOLLANDALE FAMILY CARE, P.C.

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1245290451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLANDALE FAMILY CARE, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 5368
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38704-5368
Country	:	US
Telephone Number	:	662-827-2214
Fax Number	:

Provider Business Practice Location Address
First Line	:	1257 HIGHWAY 61 SOUTH
Second Line	:
City	:	HOLLANDALE
State	:	MS
Zip	:	38748
Country	:	US
Telephone Number	:	662-827-2214
Fax Number	:	662-827-5019

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN L HERZOG SR.
Credential	:	M.D.
Telephone Number	:	662-843-6034

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	05/20/2021

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