Provider Demographics
NPI:1053393579
Name:HOLLY, DALE CRAWFORD (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:CRAWFORD
Last Name:HOLLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:STE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-0920
Mailing Address - Country:US
Mailing Address - Phone:404-885-7701
Mailing Address - Fax:404-885-7777
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-351-9512
Practice Address - Fax:404-351-9815
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA32335207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00463295DMedicaid
GA10BBCGFMedicare ID - Type Unspecified
GAE35746Medicare UPIN