MEDICARE: MATTHEW SCOTT HOLT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1487889085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW SCOTT HOLT PA-C

Provider Business Mailing Address
First Line	:	509 LUMPKIN RD
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-6552
Country	:	US
Telephone Number	:	706-610-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 WATKINS AVE BLDG 8052
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-5529
Country	:	US
Telephone Number	:	706-544-2189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	05/27/2009

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