Healthcare Provider Details

I. General information

NPI: 1649688193
Provider Name (Legal Business Name): AMANDA FRAME NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 13TH ST
AUGUSTA GA
30901-1015
US

IV. Provider business mailing address

1125 TROUPE ST
AUGUSTA GA
30904-4480
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-2500
  • Fax: 706-823-5928
Mailing address:
  • Phone: 706-737-4575
  • Fax: 706-731-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN204611
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN204611
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: