Provider Demographics
NPI:1992111371
Name:ERWIN, AMANDA (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:ERWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1818
Mailing Address - Country:US
Mailing Address - Phone:706-283-8190
Mailing Address - Fax:
Practice Address - Street 1:22 LAUREL DR
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1818
Practice Address - Country:US
Practice Address - Phone:706-283-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist