Provider Demographics
NPI:1235432519
Name:HALE, AMANDA KNAUER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KNAUER
Last Name:HALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SUTHERLIN DR STE 1C
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2259
Mailing Address - Country:US
Mailing Address - Phone:478-287-6144
Mailing Address - Fax:
Practice Address - Street 1:114 SUTHERLIN DR STE 1C
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2259
Practice Address - Country:US
Practice Address - Phone:478-287-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5964363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126689BMedicaid
GA003126689AMedicaid
GA202I972067Medicare PIN