Provider Demographics
NPI:1376188821
Name:HOLMES, AMANDA (DOULA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 HERRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-4239
Mailing Address - Country:US
Mailing Address - Phone:808-209-2012
Mailing Address - Fax:
Practice Address - Street 1:764 HERRINGTON DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-4239
Practice Address - Country:US
Practice Address - Phone:808-209-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty