Healthcare Provider Details

I. General information

NPI: 1730379595
Provider Name (Legal Business Name): AMANDA D. VUPPALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA M DAVIS MD

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 SINGLETON RIDGE RD
CONWAY SC
29526-9150
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTN CREDENTIALING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-8050
  • Fax: 843-347-8049
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD.201465
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number33517
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: