Provider Demographics
NPI:1558750752
Name:LEE, AMANDA FRANCES (AGNP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:FRANCES
Last Name:LEE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 FOREST FALLS DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3441
Mailing Address - Country:US
Mailing Address - Phone:678-859-6013
Mailing Address - Fax:
Practice Address - Street 1:5416 FOREST FALLS DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3441
Practice Address - Country:US
Practice Address - Phone:678-859-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216926363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health