Healthcare Provider Details

I. General information

NPI: 1891030060
Provider Name (Legal Business Name): AMANDA BATES LANTHRIPP LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA NEAL BATES

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N. JEFFERSON ST.
MILLEDGEVILLE GA
31061-2606
US

IV. Provider business mailing address

PO BOX 1827
MILLEDGEVILLE GA
31059-1827
US

V. Phone/Fax

Practice location:
  • Phone: 478-445-4817
  • Fax: 478-445-4963
Mailing address:
  • Phone: 478-445-4817
  • Fax: 478-445-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW005377
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: