Healthcare Provider Details

I. General information

NPI: 1437697893
Provider Name (Legal Business Name): HOLLY MUSGROVE GUTTSHALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 PLEASANT HILL RD
DULUTH GA
30096-4807
US

IV. Provider business mailing address

11705 JONES BRIDGE RD STE A201
JOHNS CREEK GA
30005-5080
US

V. Phone/Fax

Practice location:
  • Phone: 770-814-8222
  • Fax: 678-205-5111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8271
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: