Healthcare Provider Details

I. General information

NPI: 1942297858
Provider Name (Legal Business Name): KEVIN H HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SUMRALL RD
COLUMBIA MS
39429-2652
US

IV. Provider business mailing address

104 PARTNERSHIP WAY
COLUMBIA MS
39429-4502
US

V. Phone/Fax

Practice location:
  • Phone: 601-736-6443
  • Fax: 601-736-2543
Mailing address:
  • Phone: 601-736-6443
  • Fax: 601-736-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15453
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: