Individual
JODY DALE HOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2700 S PROVIDENCE RD, STE 300, WAXHAW, NC 28173-6313
(704) 243-2254
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200200918
NC
Other
Enumeration date
08/09/2005
Last updated
07/15/2024
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