Provider Demographics
NPI:1356011423
Name:MILEHAM, AMANDA DANIELLE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DANIELLE
Last Name:MILEHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:DANIELLE
Other - Last Name:TRIEMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1175 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-4321
Mailing Address - Country:US
Mailing Address - Phone:678-614-4323
Mailing Address - Fax:
Practice Address - Street 1:1175 BELL AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4321
Practice Address - Country:US
Practice Address - Phone:678-614-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant