Provider Demographics
NPI:1699768168
Name:HOLZWARTH, MONICA ELLEN (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ELLEN
Last Name:HOLZWARTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2764
Mailing Address - Country:US
Mailing Address - Phone:770-971-5325
Mailing Address - Fax:770-971-3093
Practice Address - Street 1:1163 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 170
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2764
Practice Address - Country:US
Practice Address - Phone:770-971-5325
Practice Address - Fax:770-971-3093
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2019-06-18
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
GA0375702080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine