Healthcare Provider Details

I. General information

NPI: 1194657890
Provider Name (Legal Business Name): KIANA HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 FIVE FORKS TRICKUM RD SW STE 203
LILBURN GA
30047-1887
US

IV. Provider business mailing address

3100 FIVE FORKS TRICKUM RD SW STE 203
LILBURN GA
30047-1887
US

V. Phone/Fax

Practice location:
  • Phone: 470-485-2220
  • Fax: 855-803-6288
Mailing address:
  • Phone: 470-485-2220
  • Fax: 855-803-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-459784
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: