MEDICARE: ERIN ANN JOLLY

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	AP60241217	WA
2	363LF0000X	Family Nurse Practitioner	RN144235	GA

General Provider Information

NPI Number	:	1689777666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN ANN JOLLY

Provider Business Mailing Address
First Line	:	PO BOX 1705
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30903-1705
Country	:	US
Telephone Number	:	706-774-7263
Fax Number	:	706-774-7230

Provider Business Practice Location Address
First Line	:	818 SAINT SEBASTIAN WAY STE 104
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2652
Country	:	US
Telephone Number	:	706-434-0130
Fax Number	:	706-434-0131

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	09/28/2020

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Directions to “ ERIN ANN JOLLY ” Practice Location

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