Basic Information
| Provider Information | |||||||||
| NPI: | 1306257035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 682 HEMLOCK ST | ||||||||
| Address2: | SUITE 490 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312016883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787411208 | ||||||||
| FaxNumber: | 4787419361 | ||||||||
| Practice Location | |||||||||
| Address1: | 682 HEMLOCK ST | ||||||||
| Address2: | SUITE 490 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312016883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787411208 | ||||||||
| FaxNumber: | 4787419361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2014 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN154237 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.