Provider Demographics
NPI:1407377237
Name:HOLMES, MADISON MCKINNON (FNP-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MCKINNON
Last Name:HOLMES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 MAPMAKER DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7818
Mailing Address - Country:US
Mailing Address - Phone:205-527-8042
Mailing Address - Fax:205-527-8042
Practice Address - Street 1:310 TOWN CENTER AVE STE A2
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7193
Practice Address - Country:US
Practice Address - Phone:678-394-0061
Practice Address - Fax:678-394-0061
Is Sole Proprietor?:No
Enumeration Date:2017-07-01
Last Update Date:2017-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner