Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Holton Deatherage

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1417534116

Holton Deatherage is a Student in an Organized Health Care Education/Training Program in Birmingham, Alabama. Licensed in Alabama. Registered with an NPI since 2021.

Licensed in
AL
In the registry since
2021
Specialties on file
2

Practice location Address checks out

1919 7th Ave S
Birmingham, AL 35233-2005
Phone: (205) 934-4507
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D-0007102-C1 (AL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1417534116
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 27, 2021
Last updated in NPPESNovember 11, 2022
Certification dateNovember 11, 2022
Mailing address1919 7th Ave S, Birmingham, AL 35233-2005

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