Provider Demographics
NPI:1225649817
Name:RODRIGUEZ, AMANDA BAYNARD (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BAYNARD
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1552 N LIMESTONE ST STE C
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4750
Practice Address - Country:US
Practice Address - Phone:864-487-0155
Practice Address - Fax:864-487-0924
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7155Medicaid
SCSCI9047628OtherMEDICARE PIN