Healthcare Provider Details

I. General information

NPI: 1780425843
Provider Name (Legal Business Name): AMANDA SIMONE ADAMS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 JONESBORO RD
MCDONOUGH GA
30253-6099
US

IV. Provider business mailing address

6551 SW COUNTY ROAD 242
LAKE CITY FL
32024-4425
US

V. Phone/Fax

Practice location:
  • Phone: 678-432-0209
  • Fax:
Mailing address:
  • Phone: 386-965-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10423
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30947
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123955
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: