MEDICARE: AMAZING FAMILY & HEALTHCARE SERVICES LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1518666346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING FAMILY & HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3326 PAPYRUS PALM RD
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3326 PAPYRUS PALM RD
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4836
Country	:	US
Telephone Number	:	678-887-4367
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EBOT B MANGA
Credential	:	NP
Telephone Number	:	678-887-4367

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	03/01/2023

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Directions to “AMAZING FAMILY & HEALTHCARE SERVICES LLC ” Practice Location

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