Provider Demographics
NPI:1487710448
Name:MAWETE, AMANDA ELAINE (MS,PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:MAWETE
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 BALABAN CIR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5190
Mailing Address - Country:US
Mailing Address - Phone:404-663-0463
Mailing Address - Fax:
Practice Address - Street 1:343 BALABAN CIR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5190
Practice Address - Country:US
Practice Address - Phone:404-663-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist