Provider Demographics
NPI:1194148767
Name:STEPHENS, AMANDA (NP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BEAR PAW CT
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-5183
Mailing Address - Country:US
Mailing Address - Phone:706-202-1483
Mailing Address - Fax:
Practice Address - Street 1:120 TRINITY PL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-2100
Practice Address - Country:US
Practice Address - Phone:706-543-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-01
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily