MEDICARE: HOLLEY M IVEY NP

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	363LF0000X	Family Nurse Practitioner	RN171157	GA

General Provider Information

NPI Number	:	1740630672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLEY M IVEY NP

Provider Business Mailing Address
First Line	:	425 W 3RD AVE STE 700
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-1969
Country	:	US
Telephone Number	:	229-312-7790
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W 3RD AVE STE 101
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-1900
Country	:	US
Telephone Number	:	229-312-5800
Fax Number	:

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

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	06/22/2016

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Directions to “ HOLLEY M IVEY NP” Practice Location

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