Individual
DR. RICHARD PAUL HOLLSTROM,JR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1555 DOCTORS DR, STE 106, LAGRANGE, GA 30240-4139
(706) 845-9370
(706) 845-9371
Mailing address
1555 DOCTORS DR, STE 106, LAGRANGE, GA 30240-4139
(706) 845-9370
(706) 845-9371
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD000988
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
723086380A
—
GA
Enumeration date
05/16/2006
Last updated
11/07/2007
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