Provider Demographics
NPI:1790965796
Name:HOLVICK, MICHAEL T (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:HOLVICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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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:404-895-8474
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:404-895-8474
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA00821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA48SCCDLMedicare PIN
GAU66791Medicare UPIN