Basic Information
| Provider Information | |||||||||
| NPI: | 1982663464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLINS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | MD(APMC) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2051 SILVERSIDE DR | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254906301 | ||||||||
| FaxNumber: | 2257659539 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 HENNESSY BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252676509 | ||||||||
| FaxNumber: | 2252676522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 04641R | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1312398 | 05 | LA | MEDICAID |