Basic Information
| Provider Information | |||||||||
| NPI: | 1588749204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLEMAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | VERNON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 CALHOUN ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294011113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437242450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 316 CALHOUN ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294011113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437242450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 29040 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 43552 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 29040 | SC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 43552 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 43552 | SC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 290401 | 05 | SC | MEDICAID | P01103667 | 01 | KY | RR MEDICARE | OTHER |