Provider Demographics
NPI:1063711380
Name:MALDONADO, AMANDA LAUREN (RT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LAUREN
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:105 SUMMER HILL WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4530
Mailing Address - Country:US
Mailing Address - Phone:912-342-3663
Mailing Address - Fax:
Practice Address - Street 1:230 DUNCAN DR BLDG 1440
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-5107
Practice Address - Country:US
Practice Address - Phone:912-315-6464
Practice Address - Fax:913-315-5397
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4350242471C3401X
GA4350242471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography