Provider Demographics
NPI:1194753525
Name:HOLDEN, SUNNY MARIA (PA)
Entity type:Individual
Prefix:MRS
First Name:SUNNY
Middle Name:MARIA
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:PROF
Other - First Name:SUNNY
Other - Middle Name:MARIA
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-8623
Mailing Address - Fax:
Practice Address - Street 1:300 E HOSPITAL ROAD, BUILDING T-300
Practice Address - Street 2:EISENHOWER ARMY MED CENTER ORTHOPEDIC SURGERY DEPT
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-6157
Practice Address - Fax:706-787-2901
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7893OtherGA MEDICAL LICENSE