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General NPI Number Information
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NPI Number | 1013542216
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Entity Type | Individual
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Provider Name | SANDRA SEEGARS HOLMES
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Gender | Female
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Dates
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Enumeration Date | 03/08/2020
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Last Update Date | 03/08/2020
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Provider Practice Location Address
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Address Line | 1836 CARROLLTON VILLA RICA HWY
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City | VILLA RICA
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State | GA
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Zip | 30180-5192
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Country | US
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Telephone | 678-997-4099
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1695
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City | FAIRBURN
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State | GA
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Zip | 30213-8011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 061218
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License Number State | GA
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