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Individual
JACK LYNN HOLLINS
Active
Individual
JACK LYNN HOLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
17380
KY
207W00000X
Ophthalmology Physician
17380
KY
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
17380
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048591
ANTHEM PROVIDER NUMBER
KY
05
—
0685503
—
OH
05
—
1679570675
—
WV
05
—
300027596
—
IN
01
—
611246763
TAX ID
KY
05
—
64173800
—
KY
Enumeration date
07/05/2005
Last updated
08/26/2019
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