Provider Demographics
NPI:1063621084
Name:THOMPSON, HOLLY A (DO)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6488 E MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7310
Mailing Address - Country:US
Mailing Address - Phone:614-860-8070
Mailing Address - Fax:614-860-8061
Practice Address - Street 1:6488 E MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7310
Practice Address - Country:US
Practice Address - Phone:614-860-8070
Practice Address - Fax:614-860-8061
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2952809Medicaid
OH2952809Medicaid