Healthcare Provider Details

I. General information

NPI: 1013958677
Provider Name (Legal Business Name): AMANDA C AUSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 S CROATAN HWY STE 1B
NAGS HEAD NC
27959-8809
US

IV. Provider business mailing address

PO BOX 1628
NAGS HEAD NC
27959-1628
US

V. Phone/Fax

Practice location:
  • Phone: 252-441-5038
  • Fax: 252-441-5216
Mailing address:
  • Phone: 252-441-5038
  • Fax: 252-441-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number9601219
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: