Provider Demographics
NPI:1548685811
Name:HOLLOWAY, ASHLEY ANN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RIVERBEND DR SW
Mailing Address - Street 2:STE 100
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6005
Mailing Address - Country:US
Mailing Address - Phone:706-378-5651
Mailing Address - Fax:706-378-8267
Practice Address - Street 1:15 RIVERBEND DR SW
Practice Address - Street 2:STE 100
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6005
Practice Address - Country:US
Practice Address - Phone:706-378-5651
Practice Address - Fax:706-378-8267
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201389363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA959774OtherWELLCARE
GA003143999AMedicaid
GA003143999BMedicaid
GA959790OtherWELLCARE
GA003143999BMedicaid