Provider Demographics
NPI:1609407600
Name:JOHNSTON, HOLLY CAROLINE (CNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CAROLINE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:CAROLINE
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8029
Mailing Address - Country:US
Mailing Address - Phone:770-721-9400
Mailing Address - Fax:770-721-9401
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 475
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8029
Practice Address - Country:US
Practice Address - Phone:770-721-9400
Practice Address - Fax:770-721-9401
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210001363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily