Individual
KATASHIA HICKS HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1367 JAMESON LN, LAWRENCEVILLE, GA 30043-8217
(912) 492-8408
Mailing address
1367 JAMESON LN, LAWRENCEVILLE, GA 30043-8217
(912) 492-8408
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012868
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199726296A
—
GA
05
—
199726296E
—
GA
05
—
199726296F
—
GA
05
—
9180176
—
GA
Enumeration date
02/21/2006
Last updated
02/06/2009
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