Provider Demographics
NPI:1194799056
Name:HOLLIDAY, III, PETER OSBORNE (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:OSBORNE
Last Name:HOLLIDAY, III
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504A HARDEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1464
Mailing Address - Country:US
Mailing Address - Phone:478-314-5000
Mailing Address - Fax:478-755-9964
Practice Address - Street 1:1504A HARDEMAN AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1464
Practice Address - Country:US
Practice Address - Phone:478-314-5000
Practice Address - Fax:478-755-9964
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026557174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00289528BMedicaid
GA00289528BMedicaid