Healthcare Provider Details

I. General information

NPI: 1982301057
Provider Name (Legal Business Name): AMANDA LEANNE KENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

3411 DURDEN DR NE UNIT 9101
BROOKHAVEN GA
30319-2237
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-6422
  • Fax:
Mailing address:
  • Phone: 404-718-9882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP286497
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberRN286497
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN286497
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: