Provider Demographics
NPI:1376711978
Name:HOLMES, JIMMIE G (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:G
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 MANHATTAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2987
Mailing Address - Country:US
Mailing Address - Phone:504-349-3690
Mailing Address - Fax:504-361-5496
Practice Address - Street 1:2845 MANHATTAN BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2987
Practice Address - Country:US
Practice Address - Phone:504-349-3690
Practice Address - Fax:504-361-5496
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPGY.2.BRG-FM207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1077909Medicaid
LA4M102Medicare PIN