Provider Demographics
NPI:1144549734
Name:HOLLOWAY, JOHN TEDDY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TEDDY
Last Name:HOLLOWAY
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 1:549 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:GA
Mailing Address - Zip Code:31542-2959
Mailing Address - Country:US
Mailing Address - Phone:912-458-2494
Mailing Address - Fax:
Practice Address - Street 1:549 CREEK DR
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:GA
Practice Address - Zip Code:31542-2959
Practice Address - Country:US
Practice Address - Phone:912-458-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016077208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice