Provider Demographics
NPI:1427942267
Name:HOLMAN, PENNY RENA
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:RENA
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 BUFORD BUSINESS BLVD # B500
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9251
Mailing Address - Country:US
Mailing Address - Phone:706-870-1331
Mailing Address - Fax:
Practice Address - Street 1:1384 BUFORD BUSINESS BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-9251
Practice Address - Country:US
Practice Address - Phone:706-870-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst