Provider Demographics
NPI:1699956904
Name:CYNTHIA J HOLIFIELD
Entity type:Organization
Organization Name:CYNTHIA J HOLIFIELD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-289-2242
Mailing Address - Street 1:915 US HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3703
Mailing Address - Country:US
Mailing Address - Phone:334-289-2242
Mailing Address - Fax:334-289-2241
Practice Address - Street 1:915 US HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3703
Practice Address - Country:US
Practice Address - Phone:334-289-2242
Practice Address - Fax:334-289-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL627332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-41261OtherBLUE CROSS BLUE SHIELD
AL009942280Medicaid
AL5841490001Medicare NSC