Provider Demographics
NPI:1942297858
Name:HOLMES, KEVIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:H
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 PARTNERSHIP WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-4502
Mailing Address - Country:US
Mailing Address - Phone:601-736-6443
Mailing Address - Fax:601-736-4641
Practice Address - Street 1:912 SUMRALL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2652
Practice Address - Country:US
Practice Address - Phone:601-736-6443
Practice Address - Fax:601-736-2543
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118863Medicaid
MS00118863Medicaid
MS110001358Medicare ID - Type UnspecifiedMC NUMBER