Provider Demographics
NPI:1992084263
Name:CROSS, HOLLY MICHELE (CNM)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELE
Last Name:CROSS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:503 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4211
Mailing Address - Country:US
Mailing Address - Phone:478-783-9340
Mailing Address - Fax:478-783-3961
Practice Address - Street 1:222 PERRY HWY STE 206
Practice Address - Street 2:PROFESSIONAL BUILDING B
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-783-9340
Practice Address - Fax:478-783-3961
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN164817367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife