MEDICARE: MRS. AMANDA KNAUER HALE PA-C

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	363AM0700X	Medical Physician Assistant	5964	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235432519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA KNAUER HALE PA-C

Provider Business Mailing Address
First Line	:	114 SUTHERLIN DR STE 1C
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2259
Country	:	US
Telephone Number	:	478-287-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 SUTHERLIN DR STE 1C
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2259
Country	:	US
Telephone Number	:	478-287-6144
Fax Number	:

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

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	11/17/2015

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