Individual
AMANDA NICHOLE MCCONNELL MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5763
(740) 446-5573
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5763
(740) 446-5573
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
34.010575
OH
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
34.010575
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0069462
—
OH
05
—
3810024041
—
WV
Enumeration date
04/30/2009
Last updated
01/11/2021
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