MEDICARE: DR. C CURTIS HOLMES PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	561	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	5813109513108800	OTHER	TRICARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	237009	OTHER	BCBS

General Provider Information

NPI Number	:	1811954456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C CURTIS HOLMES PHD

Provider Business Mailing Address
First Line	:	121 CARL VINSON PKWY
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-5817
Country	:	US
Telephone Number	:	478-922-2365
Fax Number	:	478-922-1778

Provider Business Practice Location Address
First Line	:	121 CARL VINSON PKWY
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-5817
Country	:	US
Telephone Number	:	478-922-2365
Fax Number	:	478-922-1778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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