Provider Demographics
NPI:1669673331
Name:CORLEY, HOLLY DAVIDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:DAVIDSON
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:3575 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1027
Practice Address - Country:US
Practice Address - Phone:770-848-5300
Practice Address - Fax:770-848-5301
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203980207R00000X
LAMD 203980208000000X
GA076690208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics