Basic Information
| Provider Information | |||||||||
| NPI: | 1194851675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLSOMBACK | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HOLSOMBACK | ||||||||
| OtherFirstName: | STEVE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1316 SOMERVILLE RD SE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356014305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563556091 | ||||||||
| FaxNumber: | 2562607337 | ||||||||
| Practice Location | |||||||||
| Address1: | 1316 SOMERVILLE RD SE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356014305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563556091 | ||||||||
| FaxNumber: | 2562607337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 1084560 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.