Provider Demographics
NPI:1063959179
Name:HOLMES, CHARLA (FNP, PNP)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:FNP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 HUDDERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6465
Mailing Address - Country:US
Mailing Address - Phone:678-428-5965
Mailing Address - Fax:
Practice Address - Street 1:5014 HUDDERSFIELD DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6465
Practice Address - Country:US
Practice Address - Phone:678-428-5965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143477163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse