Provider Demographics
NPI:1336460922
Name:HOLL, JENNIFER SAMPLES (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SAMPLES
Last Name:HOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:SAMPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1725
Mailing Address - Country:US
Mailing Address - Phone:404-252-5669
Mailing Address - Fax:404-252-9473
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1725
Practice Address - Country:US
Practice Address - Phone:404-252-5669
Practice Address - Fax:404-252-9473
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162888208C00000X
GA103860208C00000X
NC2018-01719208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336460922Medicaid