Provider Demographics
NPI:1457999831
Name:PANOS, AMANDA HOPE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:HOPE
Last Name:PANOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 SPRINGHARBOR DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5722
Mailing Address - Country:US
Mailing Address - Phone:760-855-8216
Mailing Address - Fax:
Practice Address - Street 1:2675 N MARTIN ST STE 700
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6981
Practice Address - Country:US
Practice Address - Phone:760-855-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical