Provider Demographics
NPI:1104026830
Name:DRISKELL, AMANDA TURNER (RN, CNM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:TURNER
Last Name:DRISKELL
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEANN
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNM
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-297-2200
Practice Address - Fax:770-534-8139
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN137545367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA252632755MMedicaid
GA252632755PMedicaid
GA252632755QMedicaid
GA252632755KMedicaid
GA941588OtherWELLCARE
GA252632755LMedicaid
GA01948455OtherAMERIGROUP
GA252632755OMedicaid
GA252632755NMedicaid