Provider Demographics
NPI:1487889085
Name:HOLT, MATTHEW SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SCOTT
Last Name:HOLT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 LUMPKIN RD
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-6552
Mailing Address - Country:US
Mailing Address - Phone:706-610-1414
Mailing Address - Fax:
Practice Address - Street 1:8830 WATKINS AVE BLDG 8052
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5529
Practice Address - Country:US
Practice Address - Phone:706-544-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant