Provider Demographics
NPI:1023171493
Name:HOLLAND, JANET (PAC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG. 100 SUITE C
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9054
Mailing Address - Country:US
Mailing Address - Phone:770-507-1414
Mailing Address - Fax:770-507-5150
Practice Address - Street 1:175 COUNTRY CLUB DR
Practice Address - Street 2:BLDG. 100 SUITE C
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9054
Practice Address - Country:US
Practice Address - Phone:770-507-1414
Practice Address - Fax:770-507-5150
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA669386353AMedicaid
GAQ32847Medicare UPIN
GA97WCGFJMedicare PIN