Provider Demographics
NPI:1316714181
Name:NORMAN, AMBER LESHEA
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LESHEA
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 BRACKETT RD NE
Mailing Address - Street 2:
Mailing Address - City:RESACA
Mailing Address - State:GA
Mailing Address - Zip Code:30735-6607
Mailing Address - Country:US
Mailing Address - Phone:706-307-9641
Mailing Address - Fax:
Practice Address - Street 1:367 RICHARDSON RD SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3619
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN076124164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse