Healthcare Provider Details

I. General information

NPI: 1124856778
Provider Name (Legal Business Name): ASHLEY HOLT CVT, CET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 MEMORIAL DR B
BARNESVILLE GA
30204-1924
US

IV. Provider business mailing address

244 MEMORIAL DR B
BARNESVILLE GA
30204-1924
US

V. Phone/Fax

Practice location:
  • Phone: 404-596-0754
  • Fax:
Mailing address:
  • Phone: 404-596-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License NumberG6S6G9X9
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: