Basic Information
| Provider Information | |||||||||
| NPI: | 1912252792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLTON | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | KAYE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 291 WIGGINS RD | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304363434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122946712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1805 MANNING DR | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304748921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125353500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN164616 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | RN164616 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.