Healthcare Provider Details

I. General information

NPI: 1598263733
Provider Name (Legal Business Name): WILLIAM HOLZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 POPLAR RD
NEWNAN GA
30265-1618
US

IV. Provider business mailing address

117 MARGARETHA DR
BOWDON GA
30108-1130
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-1745
  • Fax:
Mailing address:
  • Phone: 770-301-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number192471
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: