Judy B Holloman
Individual provider Active NPI Pharmacist · Hull, GA
NPI 1003355140 · NPPES record last updated Feb 22, 2017
Key facts
- NPI
- 1003355140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 020458 (GA)
- Practice address
- 9161 Highway 29 S
Hull, GA 30646-3772 - Phone
- (706) 613-1734
- Fax
- (706) 613-1909
- NPI assigned
- Feb 22, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020458 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ingles Markets Inc | Past | Accepting new patients | |
| Ingles Markets Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 020458 | GA | Yes |
Addresses
Primary practice location
9161 Highway 29 S
Hull, GA 30646-3772
Mailing address
9161 Highway 29 S
Hull, GA 30646-3772
Phone (706) 613-1734
Other providers in Hull, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.