Healthcare Provider Details

I. General information

NPI: 1699357640
Provider Name (Legal Business Name): AMANDA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BRITT

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWINING ST # 760
MONTGOMERY AL
36112-6027
US

IV. Provider business mailing address

300 TWINING ST # 760
MONTGOMERY AL
36112-6027
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-1933
  • Fax:
Mailing address:
  • Phone: 601-434-9645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number312420
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number312420
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: