Provider Demographics
NPI:1609931369
Name:BROOKS-OWENS, AMANDA
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BROOKS-OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6251
Mailing Address - Country:US
Mailing Address - Phone:478-929-2203
Mailing Address - Fax:478-994-7611
Practice Address - Street 1:168 OLD BRENT RD
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-6911
Practice Address - Country:US
Practice Address - Phone:478-994-7600
Practice Address - Fax:478-994-7611
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker