Healthcare Provider Details

I. General information

NPI: 1669455465
Provider Name (Legal Business Name): AMANDA SILVER HOVIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ELM ST.
MCADENVILLE NC
28101
US

IV. Provider business mailing address

105 ELM ST.
MCADENVILLE NC
28101
US

V. Phone/Fax

Practice location:
  • Phone: 704-824-5323
  • Fax: 704-824-5410
Mailing address:
  • Phone: 704-824-5323
  • Fax: 704-824-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103114
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: