Provider Demographics
NPI:1912906918
Name:HOLLEY, JEFFREY NEAL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:NEAL
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:MD
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 637
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-0637
Mailing Address - Country:US
Mailing Address - Phone:229-524-2232
Mailing Address - Fax:229-524-8766
Practice Address - Street 1:214 CHERRY ST
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1616
Practice Address - Country:US
Practice Address - Phone:229-524-2232
Practice Address - Fax:229-524-8766
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
GA038013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBRKPMedicare ID - Type Unspecified
GAGRP6806Medicare ID - Type Unspecified
GAF85716Medicare UPIN