Provider Demographics
NPI:1598524837
Name:HOLDER, KAITLYN DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:DENISE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 HWY 18 EAST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211
Mailing Address - Country:US
Mailing Address - Phone:478-251-4285
Mailing Address - Fax:
Practice Address - Street 1:115 CHERRY ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7205
Practice Address - Country:US
Practice Address - Phone:770-793-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207P00000X207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine