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
State | License ID | Taxonomies |
---|---|---|
GA | D8X9Y4N6 | 246YR1600X, 246Y00000X |
GA | 172A00000X | |
GA | Y3E3L5L4 | 183700000X |
GA | Z8F6D6D7 | 246RP1900X, 374700000X |
GA | L8E7A6L3 | 372500000X, 372600000X, 3747A0650X, 3747P1801X, 374U00000X, 3747P1801X, 374U00000X |
GA | T5Y4Z2P6 | 376K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 374U00000X | Nursing Service Related Providers | Home Health Aide | |
No | 246YR1600X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Health Information | Registered Record Administrator |
No | 172A00000X | Other Service Providers | Driver | |
No | 183700000X | Pharmacy Service Providers | Pharmacy Technician | |
No | 246RP1900X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy |
No | 246Y00000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Health Information | |
No | 372500000X | Nursing Service Related Providers | Chore Provider | |
No | 372600000X | Nursing Service Related Providers | Adult Companion | |
No | 374700000X | Nursing Service Related Providers | Technician | |
No | 3747A0650X | Nursing Service Related Providers | Technician | Attendant Care Provider |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant |
No | 376K00000X | Nursing Service Related Providers | Nurse's Aide |