Provider Demographics
NPI:1598957557
Name:DYER, AMANDA DIX (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DIX
Last Name:DYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0024
Mailing Address - Country:US
Mailing Address - Phone:706-410-4074
Mailing Address - Fax:706-664-0459
Practice Address - Street 1:47 GREENSBORO HWY STE 3
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2515
Practice Address - Country:US
Practice Address - Phone:706-410-4074
Practice Address - Fax:706-664-0459
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3109103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist