=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700868817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL T HOLVICK DPM PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2005
-----------------------------------------------------
Last Update Date | 04/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1729 DUNWOODY PL NE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30324-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-895-8474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1729 DUNWOODY PL NE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30324-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-895-8474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHYSICIAN
-----------------------------------------------------
Name | DR. MICHAEL T HOLVICK
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 404-895-8474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 00821
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------