Provider Demographics
NPI:1346485679
Name:BOSTWICK, AMELIA SHEEHAN (MD)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:SHEEHAN
Last Name:BOSTWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:CLAIRE
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:114 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1309
Mailing Address - Country:US
Mailing Address - Phone:912-588-1020
Mailing Address - Fax:912-588-1002
Practice Address - Street 1:114 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1309
Practice Address - Country:US
Practice Address - Phone:912-588-1020
Practice Address - Fax:912-588-1002
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA75959207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program