MEDICARE: SAMUEL F HOLLINGSWORTH 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
1	207W00000X	Ophthalmology Physician	7436	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51011572	OTHER	AL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790890986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL F HOLLINGSWORTH M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	05/02/2008

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