Healthcare Provider Details

I. General information

NPI: 1306399670
Provider Name (Legal Business Name): SEAN HOLLOWAY AGACNP-BC / FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SEAN HOLLOWAY ARNP

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 VERNON RD STE A
LAGRANGE GA
30240-4143
US

IV. Provider business mailing address

1600 VERNON RD STE A
LAGRANGE GA
30240-4143
US

V. Phone/Fax

Practice location:
  • Phone: 706-803-8799
  • Fax:
Mailing address:
  • Phone: 706-803-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN 9232842
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9232842
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9232842
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN325179
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: