Provider Demographics
NPI:1609227131
Name:HOWARD G HOLMES MD INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:HOWARD G HOLMES MD INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-271-0070
Mailing Address - Street 1:460 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5782
Mailing Address - Country:US
Mailing Address - Phone:865-271-0070
Mailing Address - Fax:865-816-3011
Practice Address - Street 1:460 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772
Practice Address - Country:US
Practice Address - Phone:865-271-0070
Practice Address - Fax:865-816-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019666Medicaid
TNQ019666Medicaid