Basic Information
| Provider Information | |||||||||
| NPI: | 1255637708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLT | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 LIVE OAK COURT | ||||||||
| Address2: | |||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317686783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299851080 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4 LIVE OAK COURT | ||||||||
| Address2: | |||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317686783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299851080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 072441 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 003149233C | 05 | GA | MEDICAID | 003149233A | 05 | GA | MEDICAID | 003149233B | 05 | GA | MEDICAID | 003149233D | 05 | GA | MEDICAID |