Provider Demographics
NPI:1740547231
Name:MANCEAU-KHA, AMANDA (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MANCEAU-KHA
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:330 23RD AVE N STE 604
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1534
Practice Address - Country:US
Practice Address - Phone:615-986-6039
Practice Address - Fax:615-234-1520
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3446207V00000X
OK5897207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1740547231OtherNPI
TN3446OtherSTATE LIC
TN620874165OtherTAX ID