Provider Demographics
NPI:1578748216
Name:HOLDER, PEGGY (NP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5669 WHITESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9054
Mailing Address - Country:US
Mailing Address - Phone:706-653-2001
Mailing Address - Fax:706-653-8287
Practice Address - Street 1:5669 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9054
Practice Address - Country:US
Practice Address - Phone:706-653-2001
Practice Address - Fax:706-653-8287
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN054833 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner