Individual provider Active NPI

Amanda Nicole Hall, CRNA

  • Certified Registered Nurse Anesthetist
  • Dothan, AL
National Provider Identifier
1134598881
Registry record updated Feb 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
802889 Issued in TX
Practice address
1108 Ross Clark Circle
Dothan, AL 36301-2911
Phone
(334) 793-8111
NPI assigned
Sep 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 802889 TX Primary

Addresses

Primary practice location

1108 Ross Clark Circle
Dothan, AL 36301-2911

Mailing address

1108 Ross Clark Circle
Dothan, AL 36301-2911
Phone (334) 793-8111

Other names 1

  • Amanda Nicole Stidham Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211101002491 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2264742527 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
5304NCMDPharmacist
802889TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Alta Anesthesia Associates of Georgia, PC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2021 Accepting new patients
Gi Anesthesia of Georgia LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2024 Accepting new patients
Medcore Associates, PLLC Current Accepting new patients
Pathology Laboratory Associates Current Accepting new patients
Coastal Ambulatory Anesthesia LLC CurrentSince Aug 1, 2024 Accepting new patients
Sentry Anesthesia Management, LLC CurrentSince Sep 21, 2021 Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

7956 Vaughn Rd
Ste 165
Montgomery, AL 36116

126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011

3100 Kemble Ave
Brunswick, GA 31520
Phone (880) 233-2570

1955 Textile Way
Gainesville, GA 30501
Phone (678) 987-1499

2000 Dan Proctor Dr
Saint Marys, GA 31558
Phone (912) 576-6160

1139 Lexington Ave
Savannah, GA 31404
Phone (912) 303-4200

13040 Abercorn St
Ste 2
Savannah, GA 31419
Phone (912) 920-1998

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487030400000",
    "number": "1134598881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 ROSS CLARK CIRCLE",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012911",
            "telephone_number": "334-793-8111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 ROSS CLARK CIRCLE",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363012911",
            "telephone_number": "334-793-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "AMANDA",
        "middle_name": "NICOLE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-23",
        "last_updated": "2017-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "802889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "STIDHAM",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.