Provider Demographics
NPI:1831453489
Name:KNAPP MELKOWITS, AMANDA (MS, PC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KNAPP MELKOWITS
Suffix:
Gender:F
Credentials:MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 RIVERVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4836
Mailing Address - Country:US
Mailing Address - Phone:706-424-4190
Mailing Address - Fax:678-680-5147
Practice Address - Street 1:6916 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1258
Practice Address - Country:US
Practice Address - Phone:770-670-7248
Practice Address - Fax:678-680-5147
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC007763OtherGA STATE LICENSE