Basic Information
| Provider Information | |||||||||
| NPI: | 1548685811 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLOWAY | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 RIVERBEND DR SW | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301616005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063785651 | ||||||||
| FaxNumber: | 7063788267 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 RIVERBEND DR SW | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301616005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063785651 | ||||||||
| FaxNumber: | 7063788267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2014 | ||||||||
| LastUpdateDate: | 07/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN201389 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LX0001X | RN201389 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 959774 | 01 | GA | WELLCARE | OTHER | 003143999A | 05 | GA | MEDICAID | 003143999B | 05 | GA | MEDICAID | 959790 | 01 | GA | WELLCARE | OTHER |