Basic Information
| Provider Information | |||||||||
| NPI: | 1104942515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAMELA Y. HOLLINS,M.D. A PROFESSIONAL MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 65077 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708965077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252676509 | ||||||||
| FaxNumber: | 2252676522 | ||||||||
| Practice Location | |||||||||
| Address1: | 4004 CONVENTION ST | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252676509 | ||||||||
| FaxNumber: | 2252676522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 09/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOLLINS | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2252676509 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 04641R | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1312398 | 05 | LA | MEDICAID |