Provider Demographics
NPI:1205943776
Name:TAYLOR, HOLLY KAY (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:KAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:KAY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 70547
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30007
Mailing Address - Country:US
Mailing Address - Phone:770-579-1894
Mailing Address - Fax:770-579-1899
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD.,
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-6104
Practice Address - Fax:404-257-1808
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001788363AS0400X
NC0010-00319363AS0400X
GA005511363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0359PAMedicaid
NC2764814Medicare PIN
GA511I970672Medicare PIN
P96607Medicare UPIN