Healthcare Provider Details

I. General information

NPI: 1689912545
Provider Name (Legal Business Name): HOLLY DEANNE STUBBLEFIELD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2013
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

V. Phone/Fax

Practice location:
  • Phone: 210-708-7476
  • Fax:
Mailing address:
  • Phone: 210-708-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN211213
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: