Basic Information
| Provider Information | |||||||||
| NPI: | 1598263733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLZ | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 MARGARETHA DR | ||||||||
| Address2: | |||||||||
| City: | BOWDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301081130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703019480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 745 POPLAR RD | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302651618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043511745 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 01/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 192471 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 192471 | 01 | GA | GEORGIA BOARD OF NURSING | OTHER |