Provider Demographics
NPI:1013629344
Name:HOLMES, ZENNIS
Entity Type:Individual
Prefix:MR
First Name:ZENNIS
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6883 GLEN COVE LN
Mailing Address - Street 2:
Mailing Address - City:STONE MTN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6310
Mailing Address - Country:US
Mailing Address - Phone:313-595-6247
Mailing Address - Fax:
Practice Address - Street 1:6883 GLEN COVE LN
Practice Address - Street 2:
Practice Address - City:STONE MTN
Practice Address - State:GA
Practice Address - Zip Code:30087-6310
Practice Address - Country:US
Practice Address - Phone:313-595-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)