Provider Demographics
NPI:1699936641
Name:FLOYD, AMANDA CLARK (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CLARK
Last Name:FLOYD
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 1:810 FAIRGROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9617
Mailing Address - Country:US
Mailing Address - Phone:828-326-3000
Mailing Address - Fax:
Practice Address - Street 1:222 HERLONG AVE S
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1158
Practice Address - Country:US
Practice Address - Phone:803-366-5500
Practice Address - Fax:803-366-5501
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC351142084A2900X, 2084N0600X, 2084N0400X
GA603712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA9989G370OtherMEDICARE PTAN
SC351149Medicaid