Healthcare Provider Details

I. General information

NPI: 1356888580
Provider Name (Legal Business Name): AMANDA CASTELLOW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 S BROAD ST
THOMASVILLE GA
31792-6113
US

IV. Provider business mailing address

454 SMITH AVE
THOMASVILLE GA
31792-5535
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8800
  • Fax: 229-226-1660
Mailing address:
  • Phone: 229-584-2540
  • Fax: 229-226-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-143545
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN302200
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1-143545
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN302200
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: