Healthcare Provider Details

I. General information

NPI: 1942120530
Provider Name (Legal Business Name): AMANDA LYNNE HORNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 GLAZIER FARMS DR
SENOIA GA
30276-6618
US

IV. Provider business mailing address

233 GLAZIER FARMS DR
SENOIA GA
30276-6618
US

V. Phone/Fax

Practice location:
  • Phone: 678-471-7769
  • Fax:
Mailing address:
  • Phone: 678-471-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPHI-023088
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: