Healthcare Provider Details

I. General information

NPI: 1578426102
Provider Name (Legal Business Name): MRS. TERESA MARAMAN HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 2ND AVE
ROCHELLE GA
31079-2046
US

IV. Provider business mailing address

374 BEMBRY RD
HAWKINSVILLE GA
31036-5238
US

V. Phone/Fax

Practice location:
  • Phone: 229-365-2570
  • Fax:
Mailing address:
  • Phone: 478-636-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN294959
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: