Basic Information
| Provider Information | |||||||||
| NPI: | 1669673331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORLEY | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | DAVIDSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742616 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303742616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702198420 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3575 BRASELTON HWY | ||||||||
| Address2: | |||||||||
| City: | DACULA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300191027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708485300 | ||||||||
| FaxNumber: | 7708485301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD.203980 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | MD 203980 | LA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 076690 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 076690 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.