=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033004684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HADYN JOLLY APC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3565 PIEDMONT RD NE STE 510
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305-8202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-282-1698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4054 VININGS MILL TRL SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-6493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-219-3649
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | APC010625
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------