Provider Demographics
NPI:1356699169
Name:SMIDT, AMANDA L (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:L
Last Name:SMIDT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MEMORIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8668
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:
Practice Address - Street 1:1107 MEMORIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8668
Practice Address - Country:US
Practice Address - Phone:706-277-7311
Practice Address - Fax:706-272-3512
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16930363LF0000X
GARN222009363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily