Provider Demographics
NPI:1992708895
Name:HOLT, MARK MANNING (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:MANNING
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 1:434 4TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3736
Mailing Address - Country:US
Mailing Address - Phone:865-647-5800
Mailing Address - Fax:865-647-5979
Practice Address - Street 1:2815 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3216
Practice Address - Country:US
Practice Address - Phone:423-254-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53118207RC0000X
TNMD33994207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY483ZMedicare PIN