Provider Demographics
NPI:1538833983
Name:HOLTZ, MADISON TAYLOR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:TAYLOR
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2807 WINDING LN NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3235
Mailing Address - Country:US
Mailing Address - Phone:678-588-4056
Mailing Address - Fax:
Practice Address - Street 1:1110 W PEACHTREE ST NW STE 1100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3609
Practice Address - Country:US
Practice Address - Phone:404-892-2131
Practice Address - Fax:404-215-9222
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA10469363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty