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Organization

HOLLIWAY MEDICAL CLINIC LLC

Active
Other names
Holliway Pediatric Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
BRONDWYN ANN HOLLIWAY MD (PHYSICIAN)
(318) 635-8606
Entity
Organization

Contact information

Practice address
3824 HEARNE AVE, SHREVEPORT, LA 71103
(318) 635-8606
(318) 635-1265
Mailing address
3824 HEARNE AVE, SHREVEPORT, LA 71103
(318) 635-8606
(318) 635-1265

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
021100
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1449423
GROUP #
LA
05
1966207
LA
Enumeration date
02/02/2007
Last updated
08/22/2020
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