Healthcare Provider Details

I. General information

NPI: 1023853330
Provider Name (Legal Business Name): AMANDA MICHELLE HEMANN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 MILLEDGEVILLE RD
AUGUSTA GA
30904-4954
US

IV. Provider business mailing address

2541 MILLEDGEVILLE RD
AUGUSTA GA
30904-4954
US

V. Phone/Fax

Practice location:
  • Phone: 706-738-2581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA004294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: