NPIMap

Organization Active NPI

Marsha Jordan Holloway, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Tifton, GA
National Provider Identifier
1992856918
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
010688 Issued in GA
Legal business name
MARSHA JORDAN HOLLOWAY, LLC
Practice address
200 12TH St W
Suite F
Tifton, GA 31794-3978
Phone
(229) 386-1616
Fax
(229) 386-4828
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Amanda Cooper
Title
Insurance Coordinator
Phone
(229) 386-1616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 010688 GA Primary

Addresses

Primary practice location

200 12TH St W
Suite F
Tifton, GA 31794-3978

Mailing address

200 12TH St W
Suite F
Tifton, GA 31794-3978
Phone (229) 386-1616

National Provider Directory

National Provider Directory
Tax ID family
Marsha Jordan Holloway LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 12th St W
Ste F
Tifton, GA 31794
Phone (229) 386-0297

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992856918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 12TH ST W",
            "address_2": "SUITE F",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943978",
            "telephone_number": "229-386-1616",
            "fax_number": "229-386-4828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 12TH ST W",
            "address_2": "SUITE F",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943978",
            "telephone_number": "229-386-1616",
            "fax_number": "229-386-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHA JORDAN HOLLOWAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "229-386-1616"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "GA",
            "license": "010688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.