Provider Demographics
NPI:1083064737
Name:HOLDER, MARIA JANE (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JANE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2205 RIVERSTONE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5250
Mailing Address - Country:US
Mailing Address - Phone:770-720-5011
Mailing Address - Fax:770-345-1088
Practice Address - Street 1:2205 RIVERSTONE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5250
Practice Address - Country:US
Practice Address - Phone:770-720-5011
Practice Address - Fax:770-345-1088
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223280363LF0000X, 363LP0808X
OR2001708004NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily