Provider Demographics
NPI:1851307383
Name:BEDINGFIELD, AMY (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:BEDINGFIELD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434-1558
Mailing Address - Country:US
Mailing Address - Phone:478-625-7000
Mailing Address - Fax:478-625-8907
Practice Address - Street 1:1067 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434-1558
Practice Address - Country:US
Practice Address - Phone:478-625-7000
Practice Address - Fax:478-625-8907
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN046188363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBBCKMedicare Oscar/Certification