Provider Demographics
NPI:1851754253
Name:HOLZGREFE, RUSSELL ERIC (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ERIC
Last Name:HOLZGREFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 TUCKERSHAM LN
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2240
Mailing Address - Country:US
Mailing Address - Phone:678-350-5259
Mailing Address - Fax:
Practice Address - Street 1:57 EXECUTIVE PARK S
Practice Address - Street 2:ROOM # 160-5
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2288
Practice Address - Country:US
Practice Address - Phone:404-778-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008683207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery