Provider Demographics
NPI:1538279005
Name:MEDLIN, AMANDA BOBB (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BOBB
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2330
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-2330
Mailing Address - Country:US
Mailing Address - Phone:843-837-4400
Mailing Address - Fax:843-837-4440
Practice Address - Street 1:350 FORDING ISLAND ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4989
Practice Address - Country:US
Practice Address - Phone:843-837-4400
Practice Address - Fax:843-837-4440
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA424ZMedicare PIN