MEDICARE: MISS AMANDA L SMIDT FNP-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
1	363LF0000X	Family Nurse Practitioner	RN222009	GA
2	363LF0000X	Family Nurse Practitioner	16930	TN

General Provider Information

NPI Number	:	1356699169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMANDA L SMIDT FNP-C

Provider Business Mailing Address
First Line	:	4700 BATTLEFIELD PKWY STE 300
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-5169
Country	:	US
Telephone Number	:	706-277-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 BATTLEFIELD PKWY STE 300
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-5169
Country	:	US
Telephone Number	:	706-406-3900
Fax Number	:

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

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	10/24/2025

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