Provider Demographics
NPI:1609889021
Name:HOLLIS, ELIZABETH MARIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4256
Mailing Address - Country:US
Mailing Address - Phone:229-246-3500
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4256
Practice Address - Country:US
Practice Address - Phone:229-246-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR138048 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA650355357BMedicaid
GA650355357BMedicaid
GAQ03887Medicare UPIN