MEDICARE: DANIEL JUDAH HOLTZ MD

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	2086S0105X	Surgery of the Hand (Surgery) Physician	62891	GA

General Provider Information

NPI Number	:	1962680991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JUDAH HOLTZ MD

Provider Business Mailing Address
First Line	:	4550 COBB PARKWAY NORTH NW
Second Line	:	SUITE #309B
City	:	ACWORTH
State	:	GA
Zip	:	30101-4180
Country	:	US
Telephone Number	:	770-917-6795
Fax Number	:	770-529-9077

Provider Business Practice Location Address
First Line	:	4550 COBB PARKWAY NORTH NW
Second Line	:	SUITE #309B
City	:	ACWORTH
State	:	GA
Zip	:	30101-4180
Country	:	US
Telephone Number	:	770-917-6795
Fax Number	:	770-529-9077

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

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	10/30/2019

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