Healthcare Provider Details

I. General information

NPI: 1972648780
Provider Name (Legal Business Name): MELISSA JANINE HOLAS D.C. MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISSY HOLAS DC, MS, ATC

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PEACHTREE ST
ATLANTA GA
30303-1723
US

IV. Provider business mailing address

1101 AUGUSTA DR SE
MARIETTA GA
30067-4448
US

V. Phone/Fax

Practice location:
  • Phone: 404-389-0931
  • Fax: 404-389-0932
Mailing address:
  • Phone: 770-517-2240
  • Fax: 770-517-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007519
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHIR007519
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: