Provider Demographics
NPI:1700868817
Name:MICHAEL T HOLVICK DPM PC
Entity Type:Organization
Organization Name:MICHAEL T HOLVICK DPM PC
Other - Org Name:PIEDMONT PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOLVICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-895-8474
Mailing Address - Street 1:1729 DUNWOODY PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2703
Mailing Address - Country:US
Mailing Address - Phone:404-895-8474
Mailing Address - Fax:
Practice Address - Street 1:1729 DUNWOODY PL NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-2703
Practice Address - Country:US
Practice Address - Phone:404-895-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty