Provider Demographics
NPI:1154356814
Name:HOLDINESS, MACK RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:MACK
Middle Name:RICHARD
Last Name:HOLDINESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 S I 10 SERVICE RD W
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7404
Mailing Address - Country:US
Mailing Address - Phone:504-885-8284
Mailing Address - Fax:504-885-8493
Practice Address - Street 1:4720 S I 10 SERVICE RD W
Practice Address - Street 2:SUITE # 207
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7404
Practice Address - Country:US
Practice Address - Phone:504-885-8284
Practice Address - Fax:504-885-8493
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA018230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1379760Medicaid
LA1379760Medicaid
LAB65171Medicare UPIN