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1962117309 NPI number — GRACE ROBERTS HOLCOMB NP

NPI Number: 1962117309
Health Care Provider/Practitioner: GRACE ROBERTS HOLCOMB NP

Information about “1962117309” NPI (GRACE ROBERTS HOLCOMB NP) exists in 1962117309 in HTML format HTML  |  1962117309 in plain Text format TXT  |  1962117309 in PDF (Portable Document Format) PDF  |  1962117309 in an XML format XML  formats.

NPI Number : 1962117309 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962117309",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLCOMB",
    "FirstName": "GRACE",
    "MiddleName": "ROBERTS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "455 PHILIP BLVD STE 140",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAWRENCEVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30046-8768",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-962-3642",
    "MailingAddressFaxNumber": "770-962-3643",
    "FirstLinePracticeLocationAddress": "1504 N THORNTON AVE STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALTON",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30720-8394",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-962-3642",
    "PracticeLocationAddressFaxNumber": "770-962-3643",
    "EnumerationDate": "01/19/2023",
    "LastUpdateDate": "10/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "RN260465",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "APRN-NP260465",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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