Provider Demographics
NPI:1518056522
Name:HOLTZ, NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:HOLTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:780 CANTON RD NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7241
Mailing Address - Country:US
Mailing Address - Phone:770-422-3602
Mailing Address - Fax:770-421-6115
Practice Address - Street 1:780 CANTON RD NE
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7241
Practice Address - Country:US
Practice Address - Phone:770-422-3602
Practice Address - Fax:770-421-6115
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA015543204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
D29784Medicare UPIN