1053533984 NPI number — CRYSTAL HOLMES HEMBREE CPHT

Table of content: CRYSTAL HOLMES HEMBREE CPHT (NPI 1053533984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053533984 NPI number — CRYSTAL HOLMES HEMBREE CPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEMBREE
Provider First Name:
CRYSTAL
Provider Middle Name:
HOLMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLMES
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053533984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
259 S CARROLL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLA RICA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30180-2627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-858-7362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 COURTHOUSE SQUARE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCHANAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-646-3570
Provider Business Practice Location Address Fax Number:
770-646-3571
Provider Enumeration Date:
05/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)