Provider Demographics
NPI:1164105334
Name:GEARHART, AMANDA (NP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GEARHART
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 OVERBEND TRL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1777
Mailing Address - Country:US
Mailing Address - Phone:770-598-1376
Mailing Address - Fax:
Practice Address - Street 1:11820 NORTHFALL LN STE 1101
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7974
Practice Address - Country:US
Practice Address - Phone:678-867-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306874363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health