Provider Demographics
NPI:1669003927
Name:COX, AMANDA (NP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 KEITH DR STE B
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4953
Mailing Address - Country:US
Mailing Address - Phone:478-988-0022
Mailing Address - Fax:478-987-0444
Practice Address - Street 1:1019 KEITH DR STE B
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4953
Practice Address - Country:US
Practice Address - Phone:478-988-0022
Practice Address - Fax:478-987-0444
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner