Provider Demographics
NPI:1053735753
Name:HOLCOMB, MINDY LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LYNN
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:LYNN
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1120 WELLSTAR WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9086
Mailing Address - Country:US
Mailing Address - Phone:470-267-0152
Mailing Address - Fax:
Practice Address - Street 1:1120 WELLSTAR WAY STE 201
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30114-9086
Practice Address - Country:US
Practice Address - Phone:470-267-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-15
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner