MEDICARE: AMANDA CAIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	037770	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	96141	OTHER	GA	BC/BS

General Provider Information

NPI Number	:	1104842954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CAIN MD

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:	770-219-8440

Provider Business Practice Location Address
First Line	:	950 S ENOTA DR NE STE B
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2439
Country	:	US
Telephone Number	:	770-531-0530
Fax Number	:	770-531-0491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	12/18/2015

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Directions to “ AMANDA CAIN MD” Practice Location

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