Healthcare Provider Details

I. General information

NPI: 1023096492
Provider Name (Legal Business Name): HOLLY WINTERBERG KOUTS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. HOLLY MCDONALD

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 KELLY RD STE 200
MCDONOUGH GA
30253-6097
US

IV. Provider business mailing address

PO BOX 746765
ATLANTA GA
30374-6765
US

V. Phone/Fax

Practice location:
  • Phone: 770-957-1887
  • Fax: 770-957-6864
Mailing address:
  • Phone: 770-914-0116
  • Fax: 770-955-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP117710
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: