Healthcare Provider Details

I. General information

NPI: 1619791381
Provider Name (Legal Business Name): AMANDA CHRISTINE WILBOURN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARKET PLACE BLVD STE 200
CARTERSVILLE GA
30121-8716
US

IV. Provider business mailing address

6 MELHANA DR SE
CARTERSVILLE GA
30120-8232
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-7253
  • Fax: 678-581-7179
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP230090
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP230090
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: