Holt, Bradley T

Holt, Bradley T is an individual health care provider with primary practice located at 1641 Madison Ave , Tifton GA 31794-3757. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Holt, Bradley T can be contacted via phone (229) 353-2284.

Contact Information

Primary practice address
1641 Madison Ave Tifton GA 31794-3757
Phone: (229) 353-2284
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 004544 Georgia

Profile Details

NPI number 1154356889
LBN Legal business name Holt, Bradley T
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Dec 1st, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154356889 NPPES
Georgia MEDICAID 777870044C
Georgia MEDICAID 777870044B

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