Individual
AMANDA SAN U PIPKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
247 ADAMS DRIVE, DEMOREST, GA 30535
(706) 839-4096
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1715
GA
363AS0400X
Surgical Physician Assistant
Primary
5323
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01457792
AMERIGROUP
GA
05
—
602701555B
—
GA
05
—
602701555C
—
GA
05
—
602701555D
—
GA
05
—
602701555E
—
GA
01
—
610308
WELLCARE
GA
Enumeration date
04/22/2008
Last updated
12/12/2024
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