Provider Demographics
NPI:1528235439
Name:HOLDER-HAYNES, JULIET GEORGIA (MD)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:GEORGIA
Last Name:HOLDER-HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 BUTLER BLVD STE E6-100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4101
Mailing Address - Country:US
Mailing Address - Phone:713-798-6673
Mailing Address - Fax:713-798-2880
Practice Address - Street 1:1977 BUTLER BLVD STE E6-100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-6673
Practice Address - Fax:713-798-2880
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4474207P00000X, 208600000X
NC2008-00702208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130872Medicare PIN
TXTXB130460Medicare PIN