Healthcare Provider Details

I. General information

NPI: 1700362878
Provider Name (Legal Business Name): AMANDA LLYN PARKERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 PLAZA AVE
EASTMAN GA
31023-6763
US

IV. Provider business mailing address

172 CAMDEN WAY
HAWKINSVILLE GA
31036-6653
US

V. Phone/Fax

Practice location:
  • Phone: 478-374-1478
  • Fax:
Mailing address:
  • Phone: 478-919-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN238917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: