Provider Demographics
NPI:1396303863
Name:HOLLAND, TERRICO
Entity type:Individual
Prefix:
First Name:TERRICO
Middle Name:
Last Name:HOLLAND
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 1:2455 FLOYD RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-9006
Mailing Address - Country:US
Mailing Address - Phone:864-245-7857
Mailing Address - Fax:
Practice Address - Street 1:2413 OLD FLOWERY BRANCH RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5617
Practice Address - Country:US
Practice Address - Phone:864-245-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)