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NPI Code Detail

MEDICARE: MR. THOMAS RYAN HOLLIFIELD PA-C

MEDICARE: MR. THOMAS RYAN HOLLIFIELD PA-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
1363A00000XPhysician Assistant103351NC

General Provider Information

NPI Number : 1487637047
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS RYAN HOLLIFIELD PA-C
Provider Business Mailing Address
First Line : 4061 PARK RD
Second Line : STE 300
City : CHARLOTTE
State : NC
Zip : 28209
Country : US
Telephone Number : 704-323-2000
Fax Number :
Provider Business Practice Location Address
First Line : 101 DELTA PARK DR
Second Line :
City : SHELBY
State : NC
Zip : 28150-3575
Country : US
Telephone Number : 704-323-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2005
Last Update Date : 05/17/2010

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Directions to “ MR. THOMAS RYAN HOLLIFIELD PA-C” Practice Location

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