Provider Demographics
NPI:1235019589
Name:HOLLOMAN, ALLYSE DELANE
Entity type:Individual
Prefix:
First Name:ALLYSE
Middle Name:DELANE
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4844 NATURE TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2771
Mailing Address - Country:US
Mailing Address - Phone:470-893-3441
Mailing Address - Fax:
Practice Address - Street 1:4844 NATURE TRL
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2771
Practice Address - Country:US
Practice Address - Phone:470-893-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty