Provider Demographics
NPI:1205377876
Name:LINGERFELT, AMANDA R (DO)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:R
Last Name:LINGERFELT
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 1:920 DIANE AVE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-8818
Mailing Address - Country:US
Mailing Address - Phone:423-735-9013
Mailing Address - Fax:
Practice Address - Street 1:106 ROGOSIN DR STE 4
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2963
Practice Address - Country:US
Practice Address - Phone:423-735-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ042542Medicaid