Healthcare Provider Details

I. General information

NPI: 1639012701
Provider Name (Legal Business Name): AMELIA CARLYLE GREATHOUSE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WESTSIDE DR
DOTHAN AL
36303-1928
US

IV. Provider business mailing address

4606 MEMPHIS CHURCH RD
DOTHAN AL
36301-8385
US

V. Phone/Fax

Practice location:
  • Phone: 335-699-2229
  • Fax: 334-699-4084
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-146890
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1-146890
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: