Provider Demographics
NPI:1518408897
Name:HOLZER, DANIEL T (CP, LP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:HOLZER
Suffix:
Gender:M
Credentials:CP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 EASTVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5756
Mailing Address - Country:US
Mailing Address - Phone:770-922-5540
Mailing Address - Fax:770-922-8535
Practice Address - Street 1:2141 EASTVIEW PKWY
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5756
Practice Address - Country:US
Practice Address - Phone:770-922-5540
Practice Address - Fax:770-922-8535
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000812853AMedicaid
GA1250340001Medicare NSC