MEDICARE: AMANDA OVERSTREET D.O.

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	207R00000X	Internal Medicine Physician	LL1412	SC
2	207R00000X	Internal Medicine Physician	1412	SC
3	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	1412	SC

General Provider Information

NPI Number	:	1952612624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA OVERSTREET D.O.

Provider Business Mailing Address
First Line	:	PO BOX 751461
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1461
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 ASHLEY AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8909
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

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

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	03/02/2022

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