Healthcare Provider Details

I. General information

NPI: 1558590588
Provider Name (Legal Business Name): ANNA I HOLBROOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365C CLIFTON RD NE SUITE C1104
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365C CLIFTON RD NE SUITE C1104
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4446
  • Fax:
Mailing address:
  • Phone: 404-778-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number65678
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: