Basic Information
| Provider Information | |||||||||
| NPI: | 1558856401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INGRAM | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | CHAMBERS | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1326 LAKE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | CEDARTOWN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301254460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063462651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 304 SHORTER AVE NW STE 105 | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301654256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062909606 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2018 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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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 | 363LP2300X | RN216149 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.