Healthcare Provider Details

I. General information

NPI: 1396376596
Provider Name (Legal Business Name): HOLLY ANN SHOEMAKER MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY ANN GROVES RN

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 S HILL ST
GRIFFIN GA
30224-4830
US

IV. Provider business mailing address

305 WHITFIELD BND
ZEBULON GA
30295-3584
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-5407
  • Fax:
Mailing address:
  • Phone: 770-584-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: