Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN226149 | GA |
NPI | 1003388679 |
---|---|
Provider Name | Mrs. Holly Allen |
First Address | Canton, GA 30115-8017 |
Second Address | Canton, GA 30115-8017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 20/12/2019 |