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NPI Code Detail

MEDICARE: AMANDA BETH SHAFER PA-C

MEDICARE: AMANDA BETH SHAFER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant4212GA
2363A00000XPhysician Assistant1089TN

General Provider Information

NPI Number : 1184674749
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA BETH SHAFER PA-C
Provider Business Mailing Address
First Line : 6522 WHITE TAIL DR
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-5868
Country : US
Telephone Number : 423-360-4845
Fax Number :
Provider Business Practice Location Address
First Line : 2347 ROSSVILLE BLVD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37408-2250
Country : US
Telephone Number : 423-265-3122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 11/15/2012

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Directions to “ AMANDA BETH SHAFER PA-C” Practice Location

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