Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 71809 | GA |
NPI | 1033381900 |
---|---|
Provider Name | Dr. Andre Lavar Holder |
First Address | Atlanta, GA 30303-3031 |
Second Address | Atlanta, GA 30303-3031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 29/03/2021 |