Active NPI
Sally Robyn Holmes, PA-C
- Physician Assistant
- Columbus, GA
National Provider Identifier
1649379751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 003490
- Practice address
- 710 Center St
Emergency Department
Columbus, GA 31901-1527 - Phone
- (706) 571-1088
- NPI assigned
- Sep 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 003490 | GA | Primary |
Addresses
Primary practice location
710 Center St
Emergency Department
Columbus, GA 31901-1527
Mailing address
14050 NW 14TH St
Suite 190
Sunrise, FL 33323-2865
Phone (954) 377-3062
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 472678928A | Medicaid | GA | |
| 472678928G | Medicaid | GA | |
| 472678928D | Medicaid | GA | |
| 472678928F | Medicaid | GA | |
| 472678928E | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003490 | GA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375056000000",
"number": "1649379751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14050 NW 14TH ST",
"address_2": "SUITE 190",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232865",
"telephone_number": "954-377-3062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 CENTER ST",
"address_2": "EMERGENCY DEPARTMENT",
"city": "COLUMBUS",
"state": "GA",
"postal_code": "319011527",
"telephone_number": "706-571-1088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLMES",
"first_name": "SALLY",
"middle_name": "ROBYN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-22",
"last_updated": "2013-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "003490",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "472678928A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "472678928G",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "472678928D",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "472678928F",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "472678928E",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.