Provider Demographics
NPI:1528516374
Name:GATTIE, AMANDA DANIELLE (CPNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DANIELLE
Last Name:GATTIE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DANIELLE
Other - Last Name:GATTIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP
Mailing Address - Street 1:5040 BILL GARDNER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3758
Mailing Address - Country:US
Mailing Address - Phone:678-583-5437
Mailing Address - Fax:678-583-5484
Practice Address - Street 1:5040 BILL GARDNER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3758
Practice Address - Country:US
Practice Address - Phone:678-583-5437
Practice Address - Fax:678-583-5484
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197686363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics