Provider Demographics
NPI:1598832883
Name:HOLMES, JAMILA A (MS, PT)
Entity Type:Individual
Prefix:MS
First Name:JAMILA
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4131
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30302-4131
Mailing Address - Country:US
Mailing Address - Phone:678-878-5396
Mailing Address - Fax:770-808-4438
Practice Address - Street 1:5065 GALLEON XING
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3054
Practice Address - Country:US
Practice Address - Phone:678-878-5396
Practice Address - Fax:770-808-4438
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68942251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000884749FMedicaid