Provider Demographics
NPI:1073845038
Name:HOLLOMAN, ANGELA L (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SUNGATE
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1260
Mailing Address - Country:US
Mailing Address - Phone:770-632-9400
Mailing Address - Fax:
Practice Address - Street 1:705 SUNGATE
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1260
Practice Address - Country:US
Practice Address - Phone:770-632-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist