Provider Demographics
NPI:1013958677
Name:AUSTIN, AMANDA C (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:C
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD
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 1628
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-1628
Mailing Address - Country:US
Mailing Address - Phone:252-441-5038
Mailing Address - Fax:252-441-5216
Practice Address - Street 1:2522 S CROATAN HWY
Practice Address - Street 2:STE 1B
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8809
Practice Address - Country:US
Practice Address - Phone:252-441-5038
Practice Address - Fax:252-441-5216
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601219173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1080UOtherBLUE CROSS BLUE SHIELD
NC891080UMedicaid
NC891080UMedicaid