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General NPI Number Information
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NPI Number | 1053818583
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Entity Type | Individual
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Provider Name | AMANDA DEADMOND MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 15813 PAUL VEGA MD DR, STE 200 MAGNOLIA OB/GYN
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City | HAMMOND
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State | LA
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Zip | 70403-1426
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Country | US
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Telephone | 985-230-7650
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Fax | 985-230-7655
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Provider Business Mailing Address
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Address Line | PO BOX 2666 PROFESSIONAL BILLING SERVICES
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City | HAMMOND
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State | LA
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Zip | 70404-2666
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Country | US
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Telephone | 985-230-3668
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Fax | 985-370-7409
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 329257
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License Number State | LA
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