Healthcare Provider Details

I. General information

NPI: 1952979569
Provider Name (Legal Business Name): CHRISTY A HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 PEACHTREE DUNWOODY RD
ATLANTA GA
30328-1606
US

IV. Provider business mailing address

6645 PEACHTREE DUNWOODY RD
ATLANTA GA
30328-1606
US

V. Phone/Fax

Practice location:
  • Phone: 770-455-7111
  • Fax: 770-455-7118
Mailing address:
  • Phone: 770-455-7111
  • Fax: 770-455-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129501801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: