Provider Demographics
NPI:1578804993
Name:HOLLIDAY, AMANDA WATERS (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:WATERS
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-7211
Mailing Address - Country:US
Mailing Address - Phone:912-223-3693
Mailing Address - Fax:
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-7211
Practice Address - Country:US
Practice Address - Phone:912-223-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist