Provider Demographics
NPI:1356330757
Name:SCOTT, HOLLY A (CPNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4030
Mailing Address - Country:US
Mailing Address - Phone:706-866-7384
Mailing Address - Fax:706-861-7003
Practice Address - Street 1:2366 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4030
Practice Address - Country:US
Practice Address - Phone:706-866-7384
Practice Address - Fax:706-861-7003
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA167868363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner