Provider Demographics
NPI:1508110255
Name:DESCALZO, AMANDA HOPE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:HOPE
Last Name:DESCALZO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:157 CLINIC AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4454
Mailing Address - Country:US
Mailing Address - Phone:770-214-2800
Mailing Address - Fax:770-214-2803
Practice Address - Street 1:690 DALLAS HWY STE 103
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1265
Practice Address - Country:US
Practice Address - Phone:770-214-2800
Practice Address - Fax:770-214-2803
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2024-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA007836363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003171912EMedicaid