Provider Demographics
NPI:1427576511
Name:JACKSON, HOLLY M (NP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 DIXIE ST STE 350
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3860
Mailing Address - Country:US
Mailing Address - Phone:770-812-5831
Mailing Address - Fax:770-812-5832
Practice Address - Street 1:706 DIXIE ST STE 350
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3860
Practice Address - Country:US
Practice Address - Phone:770-812-5831
Practice Address - Fax:770-812-5832
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAAPRN-NP216051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily