Provider Demographics
NPI:1467439851
Name:GOLDNER, AMANDA LEIGH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEIGH
Last Name:GOLDNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5669 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1767
Mailing Address - Country:US
Mailing Address - Phone:404-851-9480
Mailing Address - Fax:404-236-0075
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1767
Practice Address - Country:US
Practice Address - Phone:404-851-9480
Practice Address - Fax:404-236-0075
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA3745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCGBVMedicare ID - Type Unspecified