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General NPI Number Information
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NPI Number | 1326387275
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Entity Type | Individual
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Provider Name | AMANDA LYNNE BREEDEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 1348 WALTON WAY STE 5100
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City | AUGUSTA
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State | GA
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Zip | 30901
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Country | US
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Telephone | 706-724-8611
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Fax | 706-724-6202
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Provider Business Mailing Address
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Address Line | PO BOX 925
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City | AUGUSTA
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State | GA
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Zip | 30903-0925
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Country | US
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Telephone | 706-724-8611
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Fax | 706-724-6202
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 006596
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License Number State | GA
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