Healthcare Provider Details

I. General information

NPI: 1124028014
Provider Name (Legal Business Name): FRANK LOVING HOLT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 MEDICAL CAMPUS DR NW SUITE 102
SUPPLY NC
28462-4093
US

IV. Provider business mailing address

3 MEDICAL CENTER DR
SUPPLY NC
28462-3350
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-5988
  • Fax: 910-754-5989
Mailing address:
  • Phone: 910-754-7790
  • Fax: 910-754-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number99-01545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: