Provider Demographics
NPI:1992962427
Name:CLINTON, AMY SOUTHERN (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SOUTHERN
Last Name:CLINTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:S
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-7050
Practice Address - Fax:864-560-0800
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3559363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00692350OtherRR MEDICARE
SCNP1262Medicaid
SCAA27553365OtherMEDICARE PIN
SCAA27554746OtherMEDICARE PIN
SC3559OtherSC LISCENSE
NC7004446Medicaid
SCAA27555019OtherMEDICARE PIN
SC3559OtherSC LISCENSE
SCP00692350OtherRR MEDICARE
SCAA27554746OtherMEDICARE PIN
SCAA27557183Medicare UPIN