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General NPI Number Information
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NPI Number | 1538833983
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Entity Type | Individual
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Provider Name | MADISON TAYLOR HOLTZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/08/2021
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 1110 W PEACHTREE ST NW STE 1100
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City | ATLANTA
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State | GA
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Zip | 30309-3609
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Country | US
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Telephone | 404-892-2131
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Fax | 404-215-9222
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Provider Business Mailing Address
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Address Line | 2807 WINDING LN NE
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3235
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Country | US
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Telephone | 678-588-4056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10469
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License Number State | GA
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