Provider Demographics
NPI:1528177623
Name:MAY, AMANDA D (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:MAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6114
Mailing Address - Country:US
Mailing Address - Phone:229-584-5400
Mailing Address - Fax:
Practice Address - Street 1:919 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6114
Practice Address - Country:US
Practice Address - Phone:229-584-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046082207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000810576IMedicaid
SCG46082Medicaid
GA000810576BMedicaid
G81496Medicare UPIN
GA000810576BMedicaid
SCG46082Medicaid