Individual
MRS. IVEY ELLIS HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
006742
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003132870
—
GA
01
—
006742
STATE LICENSE
GA
05
—
147458
—
AL
Enumeration date
03/13/2013
Last updated
11/19/2020
Update your record
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