Provider Demographics
NPI:1962462762
Name:HOLWERDA, DENNIS LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:LEWIS
Last Name:HOLWERDA
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 1:1801 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1572
Mailing Address - Country:US
Mailing Address - Phone:229-434-1400
Mailing Address - Fax:229-434-0040
Practice Address - Street 1:1801 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1572
Practice Address - Country:US
Practice Address - Phone:229-434-1400
Practice Address - Fax:229-434-0040
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA294702080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine