Provider Demographics
NPI:1356677561
Name:HOLMES, PAMELA MARICE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARICE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3043
Mailing Address - Country:US
Mailing Address - Phone:770-572-1629
Mailing Address - Fax:770-774-1037
Practice Address - Street 1:24 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-3043
Practice Address - Country:US
Practice Address - Phone:770-572-1629
Practice Address - Fax:770-774-1037
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0012921699376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide