Provider Demographics
NPI:1679007439
Name:HAMIL, HOLLY NICOLE (DO)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICOLE
Last Name:HAMIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:NICOLE
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3957 CLEVELAND HWY STE B
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-2052
Mailing Address - Country:US
Mailing Address - Phone:706-852-2374
Mailing Address - Fax:706-852-2375
Practice Address - Street 1:200 NEW YORK AVE STE 150
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5227
Practice Address - Country:US
Practice Address - Phone:865-835-5850
Practice Address - Fax:865-374-1115
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86086207Q00000X
390200000X
TN5960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ098209Medicaid