Basic Information
| Provider Information | |||||||||
| NPI: | 1619204757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRUDWICK | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2015 UPPERGATE DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047275642 | ||||||||
| FaxNumber: | 4047278249 | ||||||||
| Practice Location | |||||||||
| Address1: | 2015 UPPERGATE DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047275642 | ||||||||
| FaxNumber: | 4047278249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2009 | ||||||||
| LastUpdateDate: | 11/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 199442 | GA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.