Healthcare Provider Details

I. General information

NPI: 1073097887
Provider Name (Legal Business Name): MATTIE ELIZABETH HOLLAR CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MATTIE ELIZABETH GOSS

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 GORDON RD STE 101
JASPER GA
30143-1017
US

IV. Provider business mailing address

53 GORDON RD STE 101
JASPER GA
30143-1017
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-9768
  • Fax: 706-692-4040
Mailing address:
  • Phone: 706-692-9768
  • Fax: 706-692-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN230895
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: