Provider Demographics
NPI:1700043460
Name:OTTO, ABBY HOLT (MD)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:HOLT
Last Name:OTTO
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 1:5780 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:11975 MORRIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4419
Practice Address - Country:US
Practice Address - Phone:770-751-3600
Practice Address - Fax:770-751-3615
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068087207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124966AMedicaid
GA003124966CMedicaid
GA003124966BMedicaid
GA003124966DMedicaid