Provider Demographics
NPI:1730900945
Name:VARGAS, AMANDA (HIS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 VETERANS PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6214
Mailing Address - Country:US
Mailing Address - Phone:706-225-8238
Mailing Address - Fax:888-965-6992
Practice Address - Street 1:6201 VETERANS PKWY STE D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6214
Practice Address - Country:US
Practice Address - Phone:706-225-8238
Practice Address - Fax:888-965-6992
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS001138237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist