Provider Demographics
NPI:1154962488
Name:HOLLIS, MARCUS LASHAWN
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:LASHAWN
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52741
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-0741
Mailing Address - Country:US
Mailing Address - Phone:404-626-8681
Mailing Address - Fax:
Practice Address - Street 1:360 PHARR RD NE APT 305
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2365
Practice Address - Country:US
Practice Address - Phone:404-626-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)