Healthcare Provider Details

I. General information

NPI: 1265794572
Provider Name (Legal Business Name): AMANDA GERMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 GORDON COMMERCIAL DR STE C
LAGRANGE GA
30240-5754
US

IV. Provider business mailing address

1940 BREWER BLVD SW
ATLANTA GA
30310-4910
US

V. Phone/Fax

Practice location:
  • Phone: 706-845-4045
  • Fax: 706-845-4367
Mailing address:
  • Phone: 404-755-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN053480
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN053480
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: