Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 015543 | GA |
NPI | 1518056522 |
---|---|
Provider Name | Dr. Noel Holtz |
First Address | Marietta, GA 30060-7241 |
Second Address | Marietta, GA 30060-7241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D29784 | (02) |