Provider Demographics
NPI:1972051522
Name:HOLLOWAY, DANIEL JAMES
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:HOLLOWAY
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 1:201 NORTHLAKE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1717
Mailing Address - Country:US
Mailing Address - Phone:601-366-4696
Mailing Address - Fax:
Practice Address - Street 1:201 NORTHLAKE AVE STE 207
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1717
Practice Address - Country:US
Practice Address - Phone:601-366-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901686363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health