Provider Demographics
NPI:1073740684
Name:HOLDSWORTH, SARAH M (APRN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:HOLDSWORTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:TANZILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:550 PEACHTREE ST NE FL 9
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2212
Mailing Address - Country:US
Mailing Address - Phone:404-778-3381
Mailing Address - Fax:404-778-4295
Practice Address - Street 1:550 PEACHTREE ST NE FL 9
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-778-3381
Practice Address - Fax:404-778-4295
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175057363LA2200X
GARN175157207YX0901X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1073740684Medicaid