MEDICARE: AMANDA JOHNSTUN

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	367500000X	Certified Registered Nurse Anesthetist	APRN-CRNA209314	GA

General Provider Information

NPI Number	:	1891150595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JOHNSTUN

Provider Business Mailing Address
First Line	:	645 SHIPLEY AVE
Second Line	:
City	:	GROVETOWN
State	:	GA
Zip	:	30813-4249
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 SHIPLEY AVE
Second Line	:
City	:	GROVETOWN
State	:	GA
Zip	:	30813-4249
Country	:	US
Telephone Number	:	706-836-8161
Fax Number	:

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

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	03/06/2026

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Directions to “ AMANDA JOHNSTUN ” Practice Location

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