Individual
CHARLES W HOLLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
216 W WALNUT ST STE A, DANVILLE, KY 40422-1832
(859) 239-5870
Mailing address
PO BOX 990, DANVILLE, KY 40423-0990
(859) 239-5870
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
041833
GA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
39268
SC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
55882
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000707836O
—
GA
05
—
GA1807
—
SC
Enumeration date
02/02/2006
Last updated
10/25/2021
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