Provider Demographics
NPI:1558432211
Name:NEWTON, HOLLI CONNER (PA)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:CONNER
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HOLLI
Other - Middle Name:LEIGH
Other - Last Name:PAULK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3727
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:3869 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3918
Practice Address - Country:US
Practice Address - Phone:678-635-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010035678363A00000X
GA4072363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA508579941BMedicaid
GA97WCFNNMedicare ID - Type Unspecified
GA508579941BMedicaid