Basic Information
| Provider Information | |||||||||
| NPI: | 1174740385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN DE VOORT | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W LINCOLN WAY | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501291685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153862488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6 HOSPITAL PARK | ||||||||
| Address2: | |||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317686700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299853320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 45023 | IA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 000517 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 46504 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 28913 | SC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 59972 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.