Provider Demographics
NPI:1093974784
Name:HOLT, LISA RENEE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:HOLT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:#9 DUNWOODY PARK
Mailing Address - Street 2:SUITE 108 ARBOR OB GYN
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-399-5055
Mailing Address - Fax:770-399-9638
Practice Address - Street 1:#9 DUNWOODY PARK
Practice Address - Street 2:SUITE 108
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-399-5055
Practice Address - Fax:770-399-9638
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN081255367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife