Provider Demographics
NPI:1417071309
Name:MIXON, AMANDA SALANITRO (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:SALANITRO
Last Name:MIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:HODSON
Other - Last Name:SALANITRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5100
Practice Address - Country:US
Practice Address - Phone:615-322-3000
Practice Address - Fax:615-936-0605
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD46243207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910688Medicaid
AL051541909OtherBCBS
AL051541925OtherBCBS
AL009910687Medicaid
AL009910688Medicaid
AL051559609Medicare PIN