Provider Demographics
NPI:1538471552
Name:HOLMES, DOROTHY CHRIS (LMT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:CHRIS
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:CHRIS
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3537 WOODLAKE RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6675
Mailing Address - Country:US
Mailing Address - Phone:706-394-9661
Mailing Address - Fax:
Practice Address - Street 1:4053 JIMMY DYESS PKWY STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9472
Practice Address - Country:US
Practice Address - Phone:706-394-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005271225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist