Provider Demographics
NPI:1932866324
Name:SAMS, AMANDA COLLINS
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:COLLINS
Last Name:SAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3825
Mailing Address - Country:US
Mailing Address - Phone:336-467-5290
Mailing Address - Fax:
Practice Address - Street 1:351 E OAK ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3825
Practice Address - Country:US
Practice Address - Phone:336-467-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician