Provider Demographics
NPI:1639216450
Name:IMLACH, HOLLY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANNE
Last Name:IMLACH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1380 MILSTEAD AVE NE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3864
Mailing Address - Country:US
Mailing Address - Phone:678-609-4913
Mailing Address - Fax:678-609-4923
Practice Address - Street 1:1380 MILSTEAD AVE NE
Practice Address - Street 2:SUITE E
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3864
Practice Address - Country:US
Practice Address - Phone:678-609-4913
Practice Address - Fax:678-609-4923
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2011-02-02
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Provider Licenses
StateLicense IDTaxonomies
GA059243207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology