Healthcare Provider Details

I. General information

NPI: 1235054719
Provider Name (Legal Business Name): AMANDA MARIE WHIRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 ROSS CLARK CIR
DOTHAN AL
36301-4744
US

IV. Provider business mailing address

1056 W KING ST
HEADLAND AL
36345-1595
US

V. Phone/Fax

Practice location:
  • Phone: 334-709-4024
  • Fax:
Mailing address:
  • Phone: 334-709-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: