Healthcare Provider Details

I. General information

NPI: 1407309800
Provider Name (Legal Business Name): AMNA KHAN HANDLEY M.S.N, BSN, RN, CIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 RUTLEDGE DR NW
SUGAR VALLEY GA
30746-5232
US

IV. Provider business mailing address

675 HOMESTEAD LN
TUSCALOOSA AL
35405-9749
US

V. Phone/Fax

Practice location:
  • Phone: 706-625-4030
  • Fax:
Mailing address:
  • Phone: 706-844-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-179895
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: