Provider Demographics
NPI:1114263050
Name:CARMICHAEL, AMANDA MICHELLE (BS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:BS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SUGAR LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6855
Mailing Address - Country:US
Mailing Address - Phone:901-258-0637
Mailing Address - Fax:
Practice Address - Street 1:7714 POPLAR AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3801
Practice Address - Country:US
Practice Address - Phone:901-516-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1679133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered