Individual
PATRICIA T HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11 OVERVIEW DR, BLUE RIDGE, GA 30513-6611
(706) 258-4040
(706) 258-4041
Mailing address
PO BOX 69, BLUE RIDGE, GA 30513-0002
(706) 258-4040
(706) 258-4041
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN030209
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00559776C
—
GA
01
—
054224
BLUE CROSS BLUE SHIELD
GA
01
—
10039454
AMERIGROUP
GA
01
—
339841
WELLCARE
GA
Enumeration date
09/27/2005
Last updated
06/18/2008
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