MEDICARE: DR. MARK MANNING HOLT M.D.

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	207RC0000X	Cardiovascular Disease Physician	C53118	CA
2	207RC0000X	Cardiovascular Disease Physician	MD33994	TN

General Provider Information

NPI Number	:	1992708895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK MANNING HOLT M.D.

Provider Business Mailing Address
First Line	:	434 4TH ST STE 201
Second Line	:
City	:	NEWPORT
State	:	TN
Zip	:	37821-3736
Country	:	US
Telephone Number	:	865-647-5800
Fax Number	:	865-647-5979

Provider Business Practice Location Address
First Line	:	2815 W ANDREW JOHNSON HWY
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-3216
Country	:	US
Telephone Number	:	423-254-5000
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/24/2022

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