Healthcare Provider Details

I. General information

NPI: 1689723868
Provider Name (Legal Business Name): TIMOTHY A. HOLT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E SOUTH BLVD STE 204
MONTGOMERY AL
36116-2460
US

IV. Provider business mailing address

301 BROWN SPRINGS RD
MONTGOMERY AL
36117-7005
US

V. Phone/Fax

Practice location:
  • Phone: 334-747-7300
  • Fax: 334-747-7320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number17514
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: