MEDICARE: HOLLY A SCOTT CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	167868	GA

General Provider Information

NPI Number	:	1356330757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY A SCOTT CPNP

Provider Business Mailing Address
First Line	:	2366 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-4030
Country	:	US
Telephone Number	:	706-866-7384
Fax Number	:	706-861-7003

Provider Business Practice Location Address
First Line	:	2366 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-4030
Country	:	US
Telephone Number	:	706-866-7384
Fax Number	:	706-861-7003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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