Individual
AMANDA MAYS LACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
366 MARKET ST, SENECA, SC 29678-0926
(864) 364-6380
(833) 853-9422
Mailing address
366 MARKET ST, SENECA, SC 29678-0926
(864) 364-6380
(833) 853-9422
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
RN162689
GA
363LG0600X
Gerontology Nurse Practitioner
Primary
23238
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP6410
—
SC
01
—
SCG565L064
MEDICARE
SC
Enumeration date
11/21/2017
Last updated
04/30/2026
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