Individual
MS. AMBER NICKOLINA TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
153 INDEPENDENCE DR, CARROLLTON, GA 30116-9000
(770) 836-6678
Mailing address
521 BOYCE RD, CHARLOTTE, NC 28211-6166
(404) 578-0479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN125386
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AC004642
MD
Other
Enumeration date
09/10/2012
Last updated
11/28/2022
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