Theron J Holtzclaw, AA

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

002172 Issued in GA

Practice address

1968 Peachtree Road NW
Atlanta, GA 30309-1281

Phone

(404) 351-1745

Fax

(404) 351-7121

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts, Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fayette Community Anesthesia

  • Anesthesiology Physician
  • Atlanta, GA
  • NPI 1144220245
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285891200000",
    "number": "1073538955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551420",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333551420",
            "telephone_number": "800-243-3839",
            "fax_number": "954-839-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 PEACHTREE ROAD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091281",
            "telephone_number": "404-351-1745",
            "fax_number": "404-351-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTZCLAW",
        "first_name": "THERON",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2010-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002172",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "002172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001111",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001111C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Travon James Holt, D.M.D.
• Nathan Le Holterman, MD
• Holton Dialysis Clinic, LLC
• Benjamin R Holton, MD
• Madison Taylor Holtz, PA-C
• Lauryn K Holtzman
• Michael T Holvick, DPM
• Brantley Oxford Holyfield, PA-C
• Adam Holzwarth, DPT
• Carlton Ross Homan, MD

• Anesthesiologist Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Anesthesiologist Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.