Provider Demographics
NPI:1891077723
Name:HOLMES, PANYA J (ARRT(R)(MR)(CT))
Entity Type:Individual
Prefix:MR
First Name:PANYA
Middle Name:J
Last Name:HOLMES
Suffix:
Gender:M
Credentials:ARRT(R)(MR)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 DAWES RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-3219
Mailing Address - Country:US
Mailing Address - Phone:251-635-3772
Mailing Address - Fax:
Practice Address - Street 1:5075 DAWES RD
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541-3219
Practice Address - Country:US
Practice Address - Phone:251-635-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL267002247100000X, 2471C3401X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging