Provider Demographics
NPI:1306257035
Name:PHILLIPS, AMANDA (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PHILLIPS
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 1:682 HEMLOCK ST
Mailing Address - Street 2:SUITE 490
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6883
Mailing Address - Country:US
Mailing Address - Phone:478-741-1208
Mailing Address - Fax:478-741-9361
Practice Address - Street 1:682 HEMLOCK ST
Practice Address - Street 2:SUITE 490
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6883
Practice Address - Country:US
Practice Address - Phone:478-741-1208
Practice Address - Fax:478-741-9361
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154237363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner