Provider Demographics
NPI:1902443039
Name:BROOKS, AMANDA (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HOSPITAL DR STE 304
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8046
Mailing Address - Country:US
Mailing Address - Phone:478-742-1010
Mailing Address - Fax:866-493-3182
Practice Address - Street 1:330 HOSPITAL DR STE 304
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8046
Practice Address - Country:US
Practice Address - Phone:478-742-1010
Practice Address - Fax:478-742-9666
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235531363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner