Basic Information
Provider Information
NPI: 1881056208
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VEAL
FirstName: HOLLY
MiddleName: FOXWORTH
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5002 WATERS AVE
Address2:  
City: SAVANNAH
State: GA
PostalCode: 314046226
CountryCode: US
TelephoneNumber: 9123508180
FaxNumber: 9123505697
Practice Location
Address1: 5002 WATERS AVE
Address2:  
City: SAVANNAH
State: GA
PostalCode: 314046226
CountryCode: US
TelephoneNumber: 9123508180
FaxNumber: 9123505697
Other Information
ProviderEnumerationDate: 03/24/2016
LastUpdateDate: 08/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN193457GAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363L00000XRN193457GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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