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NPI Code Detail

MEDICARE: AMANDA GREENWELL AU.D.

MEDICARE: AMANDA GREENWELL AU.D.
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
1231H00000XAudiologist

General Provider Information

NPI Number : 1306214846
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA GREENWELL AU.D.
Provider Business Mailing Address
First Line : 200 DOCTORS DR
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4559
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 DOCTORS DR
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4559
Country : US
Telephone Number : 850-784-7722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2015
Last Update Date : 04/27/2016

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