Healthcare Provider Details

I. General information

NPI: 1285956979
Provider Name (Legal Business Name): DR. BARON HOLT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 LYNN RD SUITE 103
RALEIGH NC
27612-6743
US

IV. Provider business mailing address

2315 LYNN RD
RALEIGH NC
27612-6743
US

V. Phone/Fax

Practice location:
  • Phone: 423-748-5095
  • Fax:
Mailing address:
  • Phone: 423-748-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number4061
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4061
License Number StateNC

VIII. Authorized Official

Name: DR. BARON GABLE HOLT
Title or Position: OWNER
Credential: D. C.
Phone: 423-748-5095