Provider Demographics
NPI:1437699006
Name:GREEN, AMANDA KAYE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAYE
Last Name:GREEN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:517 GREAT OAKS DRIVE SUITE 103
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655
Mailing Address - Country:US
Mailing Address - Phone:770-207-7916
Mailing Address - Fax:770-267-9840
Practice Address - Street 1:517 GREAT OAKS DRIVE SUITE 103
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:770-207-7916
Practice Address - Fax:770-267-9840
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209452363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics