Healthcare Provider Details

I. General information

NPI: 1962680991
Provider Name (Legal Business Name): DANIEL JUDAH HOLTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 COBB PARKWAY NORTH NW SUITE #309B
ACWORTH GA
30101-4180
US

IV. Provider business mailing address

4550 COBB PARKWAY NORTH NW SUITE #309B
ACWORTH GA
30101-4180
US

V. Phone/Fax

Practice location:
  • Phone: 770-917-6795
  • Fax: 770-529-9077
Mailing address:
  • Phone: 770-917-6795
  • Fax: 770-529-9077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number62891
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: