Healthcare Provider Details

I. General information

NPI: 1235661273
Provider Name (Legal Business Name): AMANDA TWILA SMALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 WHITE HORSE RD
GREENVILLE SC
29611-6120
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-331-0560
  • Fax: 864-241-9277
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number92386
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: