Active NPI
Andrew Holiday III
- Pastoral Counselor
- College Park, GA
National Provider Identifier
1225406366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- Practice address
- 5436 Riverdale Rd Ste 115
College Park, GA 30349-6100 - Phone
- (860) 478-7052
- NPI assigned
- Sep 6, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | GA | Primary |
Addresses
Primary practice location
5436 Riverdale Rd Ste 115
College Park, GA 30349-6100
Mailing address
868 Cormac Dr
Riverdale, GA 30296-7195
Phone (860) 478-7052
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441584000000",
"number": "1225406366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "868 CORMAC DR",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302967195",
"telephone_number": "860-478-7052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5436 RIVERDALE RD STE 115",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303496100",
"telephone_number": "860-478-7052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLIDAY",
"first_name": "ANDREW",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-06",
"last_updated": "2015-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Park, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.