Jacob Harvey Holley III, M.D.
Individual provider Active NPI General Practice Physician · Donalsonville, GA
NPI 1962842013 · NPPES record last updated Jan 7, 2025
Key facts
- NPI
- 1962842013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 81053 (GA)
- Practice address
- 214 Cherry St
Donalsonville, GA 39845-1616 - Phone
- (229) 524-2232
- Fax
- (229) 524-8766
- NPI assigned
- Jul 2, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Medical College of Georgia School of Medicine, 2013
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Southwest Georgia Healthcare Clinics, Inc.
Practice addresses (Care Compare)
219 S Wiley Ave
Donalsonville, GA 39845-1628
Phone (229) 524-1307
Hospital & facility affiliations
- Centerwell Home Health
- Georgia Hospice Care
- Donalsonville Hospital Inc
- Seminole Manor Nursing Home
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181022001718 | GA | Practitioner - General Surgery | 6901032085 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36063 | SC | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Georgia Healthcare Clinics Inc | Current | Accepting new patients | |
| Southwest Georgia Healthcare Clinics Inc | Current |
Accepting new patients | |
| Southwest Georgia Healthcare Clinics, Inc | Current |
Accepting new patients | |
| Jeffrey N Holley MD PC | Current |
Accepting new patients | |
| Donalsonville Hospital Inc | Current |
Accepting new patients | |
| Hospital Authority of the City of Bainbridge and Decatur County | Past | Accepting new patients |
Locations
205 Bresee St
Donalsonville, GA 39845
Phone (229) 524-1307
102 Hospital Cir
Donalsonville, GA 39845
Phone (229) 524-8489
214 Cherry St
Donalsonville, GA 39845
Phone (229) 524-2232
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 36063 | SC | |
| General Practice Physician | 208D00000X | 81053 | GA | Yes |
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
Other providers in Donalsonville, GA
- Sarah Walker Hampton
- Candice Nicole Hardeman
- Scott Hartzog
- Sherry R Hawkins
- Murdoc Michael Henderson
- Jeffrey Neal Holley
- Tukessa M Hopson
- Leslie Brooke Hornsby
- Mary M. Hunt
- Richard Owen Hunt
All providers in Donalsonville, GA · General Practice Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.