Provider Demographics
NPI:1528360765
Name:HOLGUIN TERRERO, GERALDO ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:GERALDO
Middle Name:ENRIQUE
Last Name:HOLGUIN TERRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GERALDO
Other - Middle Name:ENRIQUE
Other - Last Name:HOLGUIN TERRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 102847
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2847
Mailing Address - Country:US
Mailing Address - Phone:770-801-2500
Mailing Address - Fax:
Practice Address - Street 1:1412 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3877
Practice Address - Country:US
Practice Address - Phone:404-350-0009
Practice Address - Fax:404-350-0280
Is Sole Proprietor?:No
Enumeration Date:2010-11-20
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54325207RP1001X
GA79228207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY698866OtherMEDICAID MANAGEMENT INFORMATION SYSTEM