Healthcare Provider Details

I. General information

NPI: 1215872569
Provider Name (Legal Business Name): AMANDA PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8203 HAZELBRAND RD NE
COVINGTON GA
30014-1510
US

IV. Provider business mailing address

2570 RIVERSIDE PKWY
LAWRENCEVILLE GA
30046-3339
US

V. Phone/Fax

Practice location:
  • Phone: 770-786-9086
  • Fax:
Mailing address:
  • Phone: 770-786-9086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN307033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: