Healthcare Provider Details

I. General information

NPI: 1730900945
Provider Name (Legal Business Name): AMANDA VARGAS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 VETERANS PKWY STE D
COLUMBUS GA
31909-6214
US

IV. Provider business mailing address

6201 VETERANS PKWY STE D
COLUMBUS GA
31909-6214
US

V. Phone/Fax

Practice location:
  • Phone: 706-225-8238
  • Fax: 888-965-6992
Mailing address:
  • Phone: 706-225-8238
  • Fax: 888-965-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001138
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: