NPIMap

Individual provider Active NPI

Jacob Harvey Holley III, M.D.

  • General Practice Physician
  • Donalsonville, GA
National Provider Identifier
1962842013
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
81053 Issued in GA
Practice address
214 Cherry St
Donalsonville, GA 39845-1616
Phone
(229) 524-2232
Fax
(229) 524-8766
NPI assigned
Jul 2, 2013
Last updated
Jan 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 36063 SC
General Practice Physician 208D00000X 81053 GA Primary

Addresses

Primary practice location

214 Cherry St
Donalsonville, GA 39845-1616

Mailing address

101 E Wood St
Spartanburg, SC 29303-3040
Phone (229) 254-1857

Other practice location 1

101 E Wood St
Spartanburg, SC 29303-3040
Phone (864) 560-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181022001718 GA Practitioner - General Surgery 6901032085 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Medical College of Georgia School of Medicine, 2013
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

219 S Wiley Ave
Donalsonville, GA 39845-1628
Phone (229) 524-1307

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
36063SCMDSurgery Physician
81053GAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Georgia Healthcare Clinics Inc CurrentSince Sep 1, 2022 Accepting new patients
Donalsonville Hospital Inc CurrentSince Sep 15, 2018 Accepting new patients
Jeffrey N Holley MD PC CurrentSince Aug 13, 2018 Accepting new patients
Southwest Georgia Healthcare Clinics Inc Current Accepting new patients
Southwest Georgia Healthcare Clinics, Inc CurrentSince Sep 1, 2022 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

102 Hospital Cir
Donalsonville, GA 39845

205 Bresee St
Donalsonville, GA 39845
Phone (229) 524-1307

214 Cherry St
Donalsonville, GA 39845
Phone (229) 524-2232

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1962842013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E WOOD ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293033040",
            "telephone_number": "229-254-1857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 CHERRY ST",
            "city": "DONALSONVILLE",
            "state": "GA",
            "postal_code": "398451616",
            "telephone_number": "229-524-2232",
            "fax_number": "229-524-8766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 E Wood St",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293033040",
            "country_code": "US",
            "telephone_number": "864-560-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLEY",
        "first_name": "JACOB",
        "middle_name": "HARVEY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-02",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "36063",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "81053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Donalsonville, GA

Sources for this page

Verify at the official NPI Registry.