Provider Demographics
NPI:1518612431
Name:LEDBETTER, AMANDA DIANNA (CCMA, CPT, PCT, CPHT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DIANNA
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:CCMA, CPT, PCT, CPHT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DIANNA
Other - Last Name:LEDBETTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CBCS, CEHRS, CMAA
Mailing Address - Street 1:4929 N MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5323
Mailing Address - Country:US
Mailing Address - Phone:678-471-6983
Mailing Address - Fax:678-403-2310
Practice Address - Street 1:4929 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5323
Practice Address - Country:US
Practice Address - Phone:678-471-6983
Practice Address - Fax:678-403-2310
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAD8X9Y4N6246YR1600X, 246Y00000X
GA172A00000X
GAY3E3L5L4183700000X
GAZ8F6D6D7246RP1900X, 374700000X
GAL8E7A6L3372500000X, 372600000X, 3747A0650X, 3747P1801X, 374U00000X, 3747P1801X, 374U00000X
GAT5Y4Z2P6376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record Administrator
No172A00000XOther Service ProvidersDriver
No183700000XPharmacy Service ProvidersPharmacy Technician
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374700000XNursing Service Related ProvidersTechnician
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide