Healthcare Provider Details

I. General information

NPI: 1053533984
Provider Name (Legal Business Name): CRYSTAL HOLMES HEMBREE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL MICHELLE HOLMES

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 COURTHOUSE SQUARE
BUCHANAN GA
30113
US

IV. Provider business mailing address

259 S CARROLL RD
VILLA RICA GA
30180-2627
US

V. Phone/Fax

Practice location:
  • Phone: 770-646-3570
  • Fax: 770-646-3571
Mailing address:
  • Phone: 678-858-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: