Provider Demographics
NPI:1295808913
Name:HOLT, HUEY T JR (MD)
Entity type:Individual
Prefix:DR
First Name:HUEY
Middle Name:T
Last Name:HOLT
Suffix:JR
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 1:540 TRINITY CREEK CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2279
Mailing Address - Country:US
Mailing Address - Phone:901-309-5000
Mailing Address - Fax:901-309-5008
Practice Address - Street 1:540 TRINITY CREEK CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2279
Practice Address - Country:US
Practice Address - Phone:901-309-5000
Practice Address - Fax:901-309-5008
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD019603174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3074777Medicare ID - Type Unspecified
TNF31819Medicare UPIN