Provider Demographics
NPI:1467726232
Name:WEBER, AMY GAGE (ANP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GAGE
Last Name:WEBER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:GAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN/BSN
Mailing Address - Street 1:1485 JESSE JEWELL PKWY NE STE 240
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3883
Mailing Address - Country:US
Mailing Address - Phone:678-961-0733
Mailing Address - Fax:678-961-0744
Practice Address - Street 1:1485 JESSE JEWELL PKWY NE STE 240
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3883
Practice Address - Country:US
Practice Address - Phone:678-961-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089310363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health