Individual
BRADLEY T HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1641 MADISON AVE, TIFTON, GA 31794-3757
(229) 353-2284
Mailing address
907 18TH ST E STE 400, TIFTON, GA 31794-3684
(229) 382-9733
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004544
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
777870044B
—
GA
05
—
777870044C
—
GA
Enumeration date
07/11/2006
Last updated
12/01/2020
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