MEDICARE: AMANDA NICOLE CANOVI

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
1	390200000X	Student in an Organized Health Care Education/Training Program	220750	GA

General Provider Information

NPI Number	:	1336031244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NICOLE CANOVI

Provider Business Mailing Address
First Line	:	300 E. HOSPITAL RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E. HOSPITAL RD.
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30905-0000
Country	:	US
Telephone Number	:	706-787-7248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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Directions to “ AMANDA NICOLE CANOVI ” Practice Location

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