Provider Demographics
NPI:1427127653
Name:BARBER, AMANDA C (PA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:BARBER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 DOUG WHITE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4180
Mailing Address - Country:US
Mailing Address - Phone:843-848-1440
Mailing Address - Fax:843-839-1654
Practice Address - Street 1:920 DOUG WHITE DR STE 130
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4180
Practice Address - Country:US
Practice Address - Phone:843-848-1440
Practice Address - Fax:843-839-1654
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3850Medicare PIN
Q23766Medicare UPIN