Basic Information
| Provider Information | |||||||||
| NPI: | 1013400852 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JERRY M HOLLEY MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8131 REBECCA WOODS DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380025798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014861151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4100 AUSTIN PEAY HWY | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381282502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014861151 | ||||||||
| FaxNumber: | 9018441439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 11/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOLLEY | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9014861151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 020391 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.