Provider Demographics
NPI:1457716805
Name:THOMAS, AMANDA BANKS (CNM)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BANKS
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MICHELE
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:803 13TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701
Mailing Address - Country:US
Mailing Address - Phone:229-434-7640
Mailing Address - Fax:229-434-7647
Practice Address - Street 1:803 13TH AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701
Practice Address - Country:US
Practice Address - Phone:229-434-7640
Practice Address - Fax:229-434-7647
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170732367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife