Individual
MRS. IVEY ELLIS HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6262 VETERANS PKWY, COLUMBUS, GA 31909-3540
(706) 324-6661
(706) 494-3201
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3008
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
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