Healthcare Provider Details

I. General information

NPI: 1508847799
Provider Name (Legal Business Name): SANDRA MARIE WITTHOLZ WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA HOLLAHAN WHNP-BC

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY ROAD NE STE 720
ATLANTA GA
30342-1628
US

IV. Provider business mailing address

980 JOHNSON FERRY ROAD NE SUITE 720
ATLANTA GA
30342-1628
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-3898
  • Fax:
Mailing address:
  • Phone: 404-252-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN-NP335552
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: