Provider Demographics
NPI:1063009041
Name:ANDREWS, AMELIA GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:GRACE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 SHERATON BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1358
Mailing Address - Country:US
Mailing Address - Phone:478-633-8700
Mailing Address - Fax:478-633-8710
Practice Address - Street 1:240 SHERATON BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1358
Practice Address - Country:US
Practice Address - Phone:478-633-8700
Practice Address - Fax:478-633-8710
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant