Healthcare Provider Details

I. General information

NPI: 1780597328
Provider Name (Legal Business Name): AMANDA KATHLEEN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PALM CIR
ADEL GA
31620-1113
US

IV. Provider business mailing address

103 PALM CIR
ADEL GA
31620-1113
US

V. Phone/Fax

Practice location:
  • Phone: 229-507-6797
  • Fax:
Mailing address:
  • Phone: 229-507-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN176373
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: