Basic Information
| Provider Information | |||||||||
| NPI: | 1902463284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALDWELL | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | BETHANY | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 ALABAMA RD | ||||||||
| Address2: | |||||||||
| City: | MEANSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302562425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067413802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1424 N EXPRESSWAY STE 121-123 | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302231753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786882820 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2019 | ||||||||
| LastUpdateDate: | 05/22/2019 | ||||||||
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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 | 363LF0000X | RN257391 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.