Healthcare Provider Details

I. General information

NPI: 1417874918
Provider Name (Legal Business Name): HOLLIANN ELIZABETH BOLTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 HIGHWAY 54 W STE 220
FAYETTEVILLE GA
30214-4552
US

IV. Provider business mailing address

707 INGRAM RD
BARNESVILLE GA
30204-3618
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-2000
  • Fax:
Mailing address:
  • Phone: 770-652-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: