Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS14412 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 85870 | GA |
NPI | 1043601842 |
---|---|
Provider Name | Saundra Holseth |
First Address | Columbus, GA 31901-1528 |
Second Address | South Miami, FL 33143-4701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2015 |
Last Update Date | 01/09/2021 |