Provider Demographics
NPI:1457425480
Name:HOLMES, ANDRE' RESHAUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE'
Middle Name:RESHAUN
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 1:915 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5011
Mailing Address - Country:US
Mailing Address - Phone:770-996-6699
Mailing Address - Fax:770-997-4790
Practice Address - Street 1:915 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5011
Practice Address - Country:US
Practice Address - Phone:770-996-6699
Practice Address - Fax:770-997-4790
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67644174400000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123920AMedicaid
GA202I292256Medicare Oscar/Certification