Provider Demographics
NPI:1720086606
Name:HOLDEN, ANTHONY AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:AUSTIN
Last Name:HOLDEN
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 1:575 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2825
Mailing Address - Country:US
Mailing Address - Phone:478-743-9762
Mailing Address - Fax:478-743-9465
Practice Address - Street 1:575 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2825
Practice Address - Country:US
Practice Address - Phone:478-743-9762
Practice Address - Fax:478-743-9465
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA335508208600000X, 208G00000X
FLME138978208G00000X
TN45381208G00000X
GA95819208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517574Medicaid
TN103I776137OtherMEDICARE
MI4120787Medicaid
MIG99392Medicare UPIN
MIOC36100009Medicare ID - Type Unspecified