Basic Information
| Provider Information | |||||||||
| NPI: | 1871715482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLAND | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 OGLETHORPE AVE | ||||||||
| Address2: | AUITE 600A | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064754933 | ||||||||
| FaxNumber: | 7062088259 | ||||||||
| Practice Location | |||||||||
| Address1: | 1199 PRINCE AVE | ||||||||
| Address2: | MSB 2ND FLOOR | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064751700 | ||||||||
| FaxNumber: | 7064571790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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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 | 207R00000X | 67710 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 67710 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 67710 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 003123963 | 05 | GA | MEDICAID |