Healthcare Provider Details

I. General information

NPI: 1962883090
Provider Name (Legal Business Name): HOLLY CHRISTINE SMITH RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WHITE ST NW STE 200
MARIETTA GA
30060-7901
US

IV. Provider business mailing address

175 WHITE ST NW STE 200
MARIETTA GA
30060-7901
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-3330
  • Fax: 770-487-7736
Mailing address:
  • Phone: 770-487-3330
  • Fax: 770-487-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN234034
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: