Provider Demographics
NPI:1801887245
Name:HOLMES, GREGORY M (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 24776
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-4776
Mailing Address - Country:US
Mailing Address - Phone:423-424-3867
Mailing Address - Fax:423-424-3879
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-983-7211
Practice Address - Fax:865-450-9374
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN14527207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3004283Medicaid
TN3004284Medicare PIN
TN050046680Medicare PIN
TN3004283Medicaid