Provider Demographics
NPI:1487235636
Name:HOLT, EDWIN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:WILLIAM
Last Name:HOLT
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 1:823 S CHURCH ST APT 1416
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4748
Mailing Address - Country:US
Mailing Address - Phone:704-287-4028
Mailing Address - Fax:
Practice Address - Street 1:1161 21ST AVE S STE B-1124
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2521
Practice Address - Country:US
Practice Address - Phone:615-322-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program