Provider Demographics
NPI:1306228887
Name:QUINN, AMANDA (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13570 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2012
Mailing Address - Country:US
Mailing Address - Phone:706-956-2665
Mailing Address - Fax:706-657-2958
Practice Address - Street 1:134 RHEA MCCLANAHAN DR
Practice Address - Street 2:
Practice Address - City:TUNNEL HILL
Practice Address - State:GA
Practice Address - Zip Code:30755-7328
Practice Address - Country:US
Practice Address - Phone:706-516-1814
Practice Address - Fax:706-965-5941
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000211956CMedicaid
GA003138289AMedicaid
GA000211956AMedicaid
GA000211956CMedicaid
GA111815Medicare Oscar/Certification
GA003138289AMedicaid