Healthcare Provider Details

I. General information

NPI: 1063939619
Provider Name (Legal Business Name): HOLLIE TEMPLES NEWBERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SHRINE RD STE 150
BRUNSWICK GA
31520-4784
US

IV. Provider business mailing address

3025 SHRINE RD STE 150
BRUNSWICK GA
31520-4784
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-5601
  • Fax: 912-466-5613
Mailing address:
  • Phone: 912-466-5601
  • Fax: 912-466-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP162509
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: