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General NPI Number Information
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NPI Number | 1265292197
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Entity Type | Individual
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Provider Name | AMANDA JANE SMITH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 1530 DEKALB AVE NE STE C
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City | ATLANTA
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State | GA
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Zip | 30307-2175
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Country | US
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Telephone | 470-280-9497
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Fax | 470-646-9789
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Provider Business Mailing Address
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Address Line | 349 ELMIRA PL NE
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City | ATLANTA
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State | GA
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Zip | 30307-2039
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Country | US
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Telephone | 404-227-4144
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN181777
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License Number State | GA
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