Healthcare Provider Details

I. General information

NPI: 1508205212
Provider Name (Legal Business Name): JASON HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

415 ARMOUR DR NE APARTMENT 4301
ATLANTA GA
30324-3933
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8865
  • Fax:
Mailing address:
  • Phone: 717-525-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA09840900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number73751
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: