Provider Demographics
NPI:1093253932
Name:HARDING, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HARDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FIRETHORN CT
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-5184
Mailing Address - Country:US
Mailing Address - Phone:404-491-9916
Mailing Address - Fax:
Practice Address - Street 1:8333 OFFICE PARK DRIVE
Practice Address - Street 2:E
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30180-6937
Practice Address - Country:US
Practice Address - Phone:404-491-9916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No251V00000XAgenciesVoluntary or Charitable