Provider Demographics
NPI:1558603811
Name:PISCIOTTA, AMANDA EANES (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:EANES
Last Name:PISCIOTTA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1180 RESURGENCE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7210
Mailing Address - Country:US
Mailing Address - Phone:706-543-5858
Mailing Address - Fax:706-543-2050
Practice Address - Street 1:1180 RESURGENCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7210
Practice Address - Country:US
Practice Address - Phone:706-543-5858
Practice Address - Fax:706-543-2050
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2015-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant