Healthcare Provider Details

I. General information

NPI: 1992708895
Provider Name (Legal Business Name): MARK MANNING HOLT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/24/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-3216
US

IV. Provider business mailing address

434 4TH ST STE 201
NEWPORT TN
37821-3736
US

V. Phone/Fax

Practice location:
  • Phone: 423-254-5000
  • Fax:
Mailing address:
  • Phone: 865-647-5800
  • Fax: 865-647-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC53118
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD33994
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: