Individual
MR. EVAN ALEXANDER HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
549 WINDCHASE LN, STONE MOUNTAIN, GA 30083-6322
(404) 680-5231
Mailing address
549 WINDCHASE LN, STONE MOUNTAIN, GA 30083-6322
(404) 680-5231
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106S00000X
TAXONOMY
—
Enumeration date
09/20/2021
Last updated
09/20/2021
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