Healthcare Provider Details

I. General information

NPI: 1346755469
Provider Name (Legal Business Name): AMANDA WATT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SPILLERS WAY
WARNER ROBINS GA
31088-0513
US

IV. Provider business mailing address

2620 ELM HILL PIKE
NASHVILLE TN
37214-3108
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-4844
  • Fax:
Mailing address:
  • Phone: 877-852-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN209660
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN209660
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: