Provider Demographics
NPI:1407801632
Name:HOLCOMB, DEBORAH DEOSS (DO)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DEOSS
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-213-1500
Mailing Address - Fax:828-651-6570
Practice Address - Street 1:125 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-3035
Practice Address - Country:US
Practice Address - Phone:828-765-4201
Practice Address - Fax:828-765-0824
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1590207R00000X, 208M00000X
NC2002-00676208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910755Medicaid
WV3810012402Medicaid
TN1517773Medicaid
TN33004682Medicare PIN
WV3810012402Medicaid
TNP00622872Medicare PIN
TN103I118165Medicare PIN