Provider Demographics
NPI:1558734434
Name:HOLISTIC HEALTH AND COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:HOLISTIC HEALTH AND COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:HOLISTIC SPECIALIST
Authorized Official - Phone:404-349-0058
Mailing Address - Street 1:5460 LEMOYNE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9206
Mailing Address - Country:US
Mailing Address - Phone:404-349-0058
Mailing Address - Fax:866-323-6778
Practice Address - Street 1:5460 LEMOYNE DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9206
Practice Address - Country:US
Practice Address - Phone:404-349-0058
Practice Address - Fax:866-323-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X
302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No302R00000XManaged Care OrganizationsHealth Maintenance Organization