Provider Demographics
NPI:1154375491
Name:HOLCOMB, CHARLIE MCILWAIN JR (AUD)
Entity type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:MCILWAIN
Last Name:HOLCOMB
Suffix:JR
Gender:M
Credentials:AUD
Other - Prefix:
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Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:AUDIOLOGY 126, VA MEDICAL CENTER
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-0951
Mailing Address - Fax:214-857-0999
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:AUDIOLOGY 126, VA MEDICAL CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0951
Practice Address - Fax:214-857-0999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX51452231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist