Provider Demographics
NPI:1467119883
Name:SCOTT, AMANDA LEAH (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEAH
Last Name:SCOTT
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PINE VIEW RD SE
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-2260
Mailing Address - Country:US
Mailing Address - Phone:614-330-0296
Mailing Address - Fax:
Practice Address - Street 1:584 N MACON ST
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316
Practice Address - Country:US
Practice Address - Phone:912-545-2107
Practice Address - Fax:912-545-2112
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN275470163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health