Basic Information
| Provider Information | |||||||||
| NPI: | 1700043460 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OTTO | ||||||||
| FirstName: | ABBY | ||||||||
| MiddleName: | HOLT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5780 PEACHTREE DUNWOODY ROAD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043031224 | ||||||||
| FaxNumber: | 4043031325 | ||||||||
| Practice Location | |||||||||
| Address1: | 11975 MORRIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300054419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707513600 | ||||||||
| FaxNumber: | 7707513615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2008 | ||||||||
| LastUpdateDate: | 08/08/2013 | ||||||||
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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 | 207V00000X | 068087 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 003124966A | 05 | GA | MEDICAID | 003124966C | 05 | GA | MEDICAID | 003124966B | 05 | GA | MEDICAID | 003124966D | 05 | GA | MEDICAID |