Individual provider Active NPI

Amanda Warren, MSN, AG-ACNP-BC

  • Acute Care Nurse Practitioner
  • Gainesville, GA
National Provider Identifier
1225792641
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
RN150028 Issued in GA
Practice address
5737 Ridgewater Dr
Gainesville, GA 30506-2391
Phone
(404) 643-7649
NPI assigned
Oct 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X RN150028 GA Primary

Addresses

Primary practice location

5737 Ridgewater Dr
Gainesville, GA 30506-2391

Mailing address

5737 Ridgewater Dr
Gainesville, GA 30506-2391
Phone (404) 643-7649

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220513001903 GA Practitioner - Nurse Practitioner 6608253562 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

450 Northside Cherokee Blvd
Canton, GA 30115-8015
Phone (770) 224-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Care Center of Georgia LLC CurrentSince Apr 20, 2022 Accepting new patients
Northside Cardiovascular Professional Services, LLC CurrentSince Aug 19, 2024 Accepting new patients

Locations

5670 Old Winder Hwy
Ste 200
Braselton, GA 30517
Phone (404) 593-0090

450 Northside Cherokee Blvd
Canton, GA 30115
Phone (770) 224-1000

663 Lanier Park Dr
Gainesville, GA 30501
Phone (678) 450-8841

1285 Upper Hembree Rd
Roswell, GA 30076
Phone (770) 343-8565

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1225792641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5737 RIDGEWATER DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305062391",
            "telephone_number": "404-643-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5737 RIDGEWATER DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305062391",
            "telephone_number": "404-643-7649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "AMANDA",
        "credential": "MSN, AG-ACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-22",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN150028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.