Healthcare Provider Details

I. General information

NPI: 1437682846
Provider Name (Legal Business Name): KHADJA HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KHADJA WHITE

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 DALLAS HWY STE 703
POWDER SPRINGS GA
30127-6458
US

IV. Provider business mailing address

5041 DALLAS HWY STE 703
POWDER SPRINGS GA
30127-6458
US

V. Phone/Fax

Practice location:
  • Phone: 404-913-6337
  • Fax: 404-393-7473
Mailing address:
  • Phone: 404-913-6337
  • Fax: 404-393-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: