MEDICARE: SAMUEL F. HOLLINGSWORTH

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1427223056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL F. HOLLINGSWORTH

Provider Business Mailing Address
First Line	:	2545 HIGHWAY 78 E
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-3433
Country	:	US
Telephone Number	:	205-221-9790
Fax Number	:	205-221-9982

Provider Business Practice Location Address
First Line	:	2545 HIGHWAY 78 E
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-3433
Country	:	US
Telephone Number	:	205-221-9790
Fax Number	:	205-221-9982

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAMUEL FRANKLIN HOLLINGSWORTH
Credential	:	M.D.
Telephone Number	:	205-221-9790

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	09/27/2010

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