Provider Demographics
NPI:1093547788
Name:HOLMES, NICHOLE (RT(R, CT))
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RT(R, CT)
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:YVONNE
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NICHOLE PUCKETT
Mailing Address - Street 1:271 ELSOMA DR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8774
Mailing Address - Country:US
Mailing Address - Phone:719-502-9447
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5180782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology