Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN146949 NP | GA |
NPI | 1033179783 |
---|---|
Provider Name | Ms. Demetrius Denise Holiday |
First Address | Atlanta, GA 30318-0656 |
Second Address | Atlanta, GA 30303-3032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2006 |
Last Update Date | 25/02/2015 |