Healthcare Provider Details

I. General information

NPI: 1104750926
Provider Name (Legal Business Name): AMANDA DIONNE EVERETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ST MATTHEWS ST
FOLKSTON GA
31537-8735
US

IV. Provider business mailing address

60 ST MATTHEWS ST
FOLKSTON GA
31537-8735
US

V. Phone/Fax

Practice location:
  • Phone: 912-282-8376
  • Fax: 912-282-8376
Mailing address:
  • Phone: 912-282-8376
  • Fax: 912-282-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: