MEDICARE: DR. AMANDA SUE GREEN DC

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	111N00000X	Chiropractor	CHIR010513	GA

General Provider Information

NPI Number	:	1730764861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA SUE GREEN DC

Provider Business Mailing Address
First Line	:	2021 N. SLAPPEY BLVD PMB# 143
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701
Country	:	US
Telephone Number	:	229-432-5617
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 WHISPERING PINES RD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3542
Country	:	US
Telephone Number	:	229-432-5617
Fax Number	:	229-883-0108

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

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	04/21/2021

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Directions to “ DR. AMANDA SUE GREEN DC” Practice Location

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