Healthcare Provider Details

I. General information

NPI: 1083524425
Provider Name (Legal Business Name): KELLY ELIZABETH HOLDWAY APC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 MERCER UNIVERSITY DR
ATLANTA GA
30341-4115
US

IV. Provider business mailing address

3001 MERCER UNIVERSITY DR
ATLANTA GA
30341-4115
US

V. Phone/Fax

Practice location:
  • Phone: 919-608-1382
  • Fax:
Mailing address:
  • Phone: 919-608-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC010597
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA233360
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: