Provider Demographics
NPI:1770116246
Name:HOLLANDSWORTH, AMANDA LEIGH (FNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:HOLLANDSWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:346 DEEP SOUTH FARM RD STE A
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-2218
Mailing Address - Country:US
Mailing Address - Phone:706-745-9417
Mailing Address - Fax:706-896-0877
Practice Address - Street 1:229 CHATUGE WAY
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3439
Practice Address - Country:US
Practice Address - Phone:706-896-7858
Practice Address - Fax:706-896-0877
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN266464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03241446BMedicaid
GARN266464OtherFNP LICENSE