Provider Demographics
NPI:1427702604
Name:HOLLEY, VERTIS L SR
Entity type:Individual
Prefix:MR
First Name:VERTIS
Middle Name:L
Last Name:HOLLEY
Suffix:SR
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 1:140 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-9712
Mailing Address - Country:US
Mailing Address - Phone:803-646-7766
Mailing Address - Fax:
Practice Address - Street 1:140 ALPINE DR APT SUITE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-9712
Practice Address - Country:US
Practice Address - Phone:803-979-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications