Provider Demographics
NPI:1205875010
Name:DOELLING, NANCY R (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:DOELLING
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 1:684 SIXES RD
Mailing Address - Street 2:STE 220
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8721
Mailing Address - Country:US
Mailing Address - Phone:678-388-5485
Mailing Address - Fax:678-388-5489
Practice Address - Street 1:684 SIXES RD
Practice Address - Street 2:STE 220
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30115-8721
Practice Address - Country:US
Practice Address - Phone:678-388-5485
Practice Address - Fax:678-388-5489
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA041199207EMedicaid
GA041199207Medicaid
GA041199207DMedicaid
H84780Medicare UPIN
GA202I372464Medicare PIN