Healthcare Provider Details

I. General information

NPI: 1295729036
Provider Name (Legal Business Name): TROY DALE HOLDERFIELD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD NE NORTHSIDE HOSPITAL DEPARTMENT OF PHARMACY
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

607 BRANDYWINE CIR
ATLANTA GA
30350-2005
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8683
  • Fax: 404-459-1680
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH014686
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberRPH014686
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH014686
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: