Basic Information
| Provider Information | |||||||||
| NPI: | 1295137941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGIVERON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | EILEEN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048740201 | ||||||||
| Practice Location | |||||||||
| Address1: | 2325 W ARBORS DRIVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282622664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953500 | ||||||||
| FaxNumber: | 7042953506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2014 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 001005231 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2882PA | 05 | SC | MEDICAID | P01911432 | 01 | NC | RAILROAD MEDICARE | OTHER |