Healthcare Provider Details

I. General information

NPI: 1811306533
Provider Name (Legal Business Name): HOLLI LYNN MCCLAIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLI LYNN WITHROW

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MAIN STREET MARKET
CARTERSVILLE GA
30121-3307
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 770-606-5212
  • Fax:
Mailing address:
  • Phone: 615-425-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN78144-FNP-BC
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN276451
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78144
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: