Healthcare Provider Details

I. General information

NPI: 1922299957
Provider Name (Legal Business Name): MICHAEL PAUL HOLCOMBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PAUL HOLCOMBE MD

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N BROAD ST NE SUITE 220
ROME GA
30161-5207
US

IV. Provider business mailing address

PO BOX 369
ROME GA
30162-0369
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-2661
  • Fax: 706-235-4177
Mailing address:
  • Phone: 706-291-2661
  • Fax: 706-235-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2007012433
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: