Healthcare Provider Details

I. General information

NPI: 1003720863
Provider Name (Legal Business Name): AMANDA PFANNENSTIEL MULL M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LANIER AVE W STE 603
FAYETTEVILLE GA
30214-7644
US

IV. Provider business mailing address

614 GRECKEN GRN
PEACHTREE CTY GA
30269-2728
US

V. Phone/Fax

Practice location:
  • Phone: 678-884-5085
  • Fax:
Mailing address:
  • Phone: 770-362-8479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP010350
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: