Individual provider Active NPI

Sean Holloway, AGACNP-BC / FNP-BC

  • Nurse Practitioner
  • Lagrange, GA
National Provider Identifier
1306399670
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN325179 Issued in GA
Practice address
1600 Vernon Rd Ste a
Lagrange, GA 30240-4143
Phone
(706) 803-8799
NPI assigned
Aug 3, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Registered Nurse 163WE0003X RN 9232842 FL
Acute Care Nurse Practitioner 363LA2100X ARNP9232842 FL
Family Nurse Practitioner 363LF0000X ARNP 9232842 FL
Nurse Practitioner 363L00000X RN325179 GA Primary

Addresses

Primary practice location

1600 Vernon Rd Ste a
Lagrange, GA 30240-4143

Mailing address

1600 Vernon Rd Ste a
Lagrange, GA 30240-4143
Phone (706) 803-8799

Other practice location 1

9555 SW 162nd Ave
Miami, FL 33196-6408
Phone (786) 467-2154

Other names 1

  • Mr. Sean Holloway Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240923001967 GA Practitioner - Nurse Practitioner 0648172353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

1510 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 845-3905

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 880-7222

3000 Hospital Blvd
Roswell, GA 30076-4915
Phone (770) 751-2912

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN 9232842FLMDEmergency Registered Nurse
RN325179GAMDNurse Practitioner
ARNP9232842FLMDAcute Care Nurse Practitioner
ARNP 9232842FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Sep 1, 2024 Accepting new patients

Locations

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

1600 Vernon Rd
Ste A
Lagrange, GA 30240
Phone (706) 880-7321

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1306399670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 VERNON RD STE A",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404143",
            "telephone_number": "706-803-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 VERNON RD STE A",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404143",
            "telephone_number": "706-803-8799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9555 SW 162nd Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331966408",
            "country_code": "US",
            "telephone_number": "786-467-2154",
            "fax_number": "786-533-9703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "SEAN",
        "name_prefix": "Mr.",
        "credential": "AGACNP-BC / FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-03",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "FL",
            "license": "RN 9232842",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "ARNP9232842",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP 9232842",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN325179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SEAN",
            "last_name": "HOLLOWAY",
            "prefix": "MR.",
            "credential": "ARNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Lagrange, GA

Sources for this page

Verify at the official NPI Registry.