Provider Demographics
NPI:1003388679
Name:ALLEN, HOLLY (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8017
Mailing Address - Country:US
Mailing Address - Phone:770-292-3490
Mailing Address - Fax:770-721-5615
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8017
Practice Address - Country:US
Practice Address - Phone:770-292-3490
Practice Address - Fax:770-721-5615
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226149363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care