Provider Demographics
NPI:1558521476
Name:HOLMBERG, SCOTT DEWEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DEWEY
Last Name:HOLMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1787
Mailing Address - Country:US
Mailing Address - Phone:404-373-7640
Mailing Address - Fax:
Practice Address - Street 1:1600 CLIFTON RD NE
Practice Address - Street 2:DVH; MAILSTOP G-37
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4018
Practice Address - Country:US
Practice Address - Phone:404-718-8550
Practice Address - Fax:404-718-8585
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine