Provider Demographics
NPI:1508641739
Name:CORDELL, AMITY R
Entity Type:Individual
Prefix:MRS
First Name:AMITY
Middle Name:R
Last Name:CORDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMITY
Other - Middle Name:RHIANNON
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2810
Mailing Address - Country:US
Mailing Address - Phone:423-509-5847
Mailing Address - Fax:
Practice Address - Street 1:134 RHEA MCCLANAHAN DR
Practice Address - Street 2:
Practice Address - City:TUNNEL HILL
Practice Address - State:GA
Practice Address - Zip Code:30755-7328
Practice Address - Country:US
Practice Address - Phone:706-935-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician