Provider Demographics
NPI:1760415749
Name:BATTISTI, AMANDA S (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:BATTISTI
Suffix:
Gender:F
Credentials:DO
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 829
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-0829
Mailing Address - Country:US
Mailing Address - Phone:843-347-8037
Mailing Address - Fax:843-347-8056
Practice Address - Street 1:300 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9142
Practice Address - Country:US
Practice Address - Phone:843-347-8037
Practice Address - Fax:843-347-8056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL993207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009939Medicaid
SCI011258822Medicare PIN
SCI01125Medicare UPIN