MEDICARE: DR. AMANDA GROUNDS JOSEPH 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	208000000X	Pediatrics Physician	034143	GA

General Provider Information

NPI Number	:	1336361187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA GROUNDS JOSEPH MD

Provider Business Mailing Address
First Line	:	1111 GLYNCO PKWY STE 31
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-7930
Country	:	US
Telephone Number	:	912-456-3605
Fax Number	:	912-456-3531

Provider Business Practice Location Address
First Line	:	1111 GLYNCO PKWY STE 31
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-7930
Country	:	US
Telephone Number	:	912-456-3605
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	02/14/2023

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