MEDICARE: AMANDA MERRELL APRN

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	RN164682	GA

General Provider Information

NPI Number	:	1649592395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MERRELL APRN

Provider Business Mailing Address
First Line	:	3135 LAKE SEMINOLE PL
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-3717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3135 LAKE SEMINOLE PL
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-3717
Country	:	US
Telephone Number	:	770-846-1399
Fax Number	:

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

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	07/18/2022

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