Provider Demographics
NPI:1982820825
Name:MIDDLETON, HOLLY KEAHEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:KEAHEY
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:141 VILLAGE PKWY NE
Mailing Address - Street 2:BUILDING 5, SUITE E
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-1514
Mailing Address - Country:US
Mailing Address - Phone:770-850-0166
Mailing Address - Fax:770-850-0010
Practice Address - Street 1:141 VILLAGE PKWY NE
Practice Address - Street 2:BUILDING 5, SUITE E
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-1514
Practice Address - Country:US
Practice Address - Phone:770-850-0166
Practice Address - Fax:770-850-0010
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2198103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent