Provider Demographics
NPI:1477002871
Name:HOLLEY, AMANDA (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 BAUGH ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1557
Mailing Address - Country:US
Mailing Address - Phone:706-424-9276
Mailing Address - Fax:
Practice Address - Street 1:378 BAUGH ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1557
Practice Address - Country:US
Practice Address - Phone:706-424-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3982111N00000X
GA009544111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor