Individual
DR. LYNWOOD BREEDEN HOLLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
35 INTERNATIONAL DR, GREENVILLE, SC 29615-4816
(864) 234-7654
(864) 675-1657
Mailing address
35 INTERNATIONAL DR, GREENVILLE, SC 29615-4816
(864) 234-7654
(864) 675-1657
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
16471
SC
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
16471
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164716
—
SC
01
—
8157
MEDICARE PTAN
SC
Enumeration date
05/01/2006
Last updated
02/19/2021
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