Provider Demographics
NPI:1326398116
Name:KING, AMANDA JEAN (BSED)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:KING
Suffix:
Gender:F
Credentials:BSED
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:SCAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12340 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:GA
Mailing Address - Zip Code:31542-2846
Mailing Address - Country:US
Mailing Address - Phone:912-458-3184
Mailing Address - Fax:912-485-3184
Practice Address - Street 1:12340 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:GA
Practice Address - Zip Code:31542-2846
Practice Address - Country:US
Practice Address - Phone:912-458-3184
Practice Address - Fax:912-485-3184
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA788391171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator