Provider Demographics
NPI:1295048932
Name:LINGENFELTER, AMY E (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:LINGENFELTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:114 TOWNPARK DR NW
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5802
Mailing Address - Country:US
Mailing Address - Phone:770-952-8612
Mailing Address - Fax:678-803-6944
Practice Address - Street 1:6300 HOSPITAL PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1828
Practice Address - Country:US
Practice Address - Phone:770-495-6258
Practice Address - Fax:770-495-8219
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN161642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I509802Medicare UPIN
GA202I509802OtherMEDICARE ID