Healthcare Provider Details

I. General information

NPI: 1043028905
Provider Name (Legal Business Name): HOLLY REBECCA NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 PEAKE RD STE 1100
MACON GA
31210-8053
US

IV. Provider business mailing address

6501 PEAKE RD STE 1100
MACON GA
31210-8053
US

V. Phone/Fax

Practice location:
  • Phone: 478-338-9140
  • Fax: 478-203-8673
Mailing address:
  • Phone: 478-338-9140
  • Fax: 478-203-8673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP294478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: