Healthcare Provider Details

I. General information

NPI: 1871456368
Provider Name (Legal Business Name): CIMONE HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL STE R
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

10103 ASHFORD GABLES DR
DUNWOODY GA
30338-7837
US

V. Phone/Fax

Practice location:
  • Phone: 678-646-8446
  • Fax:
Mailing address:
  • Phone: 678-646-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: