MEDICARE: CAROLINE MARIE HOLT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		GA

General Provider Information

NPI Number	:	1073471850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE MARIE HOLT PA-C

Provider Business Mailing Address
First Line	:	550 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2212
Country	:	US
Telephone Number	:	404-686-4684
Fax Number	:	404-686-4688

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2212
Country	:	US
Telephone Number	:	404-686-4684
Fax Number	:	404-686-4688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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