Individual
MISS AMANDA VALLEN HEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
5211 HIGHWAY 278 NE, COVINGTON, GA 30014-2671
(770) 787-7444
(770) 787-5050
Mailing address
2041 BURNING BUSH LN, CONYERS, GA 30094-1120
(678) 735-0524
(770) 787-5050
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
RN102177
GA
363LP0200X
Pediatric Nurse Practitioner
Primary
RN181771
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN181771
—
GA
Enumeration date
03/19/2019
Last updated
04/19/2022
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