Individual provider Active NPI

Amanda Phillips, M.D.

  • Obstetrics & Gynecology Physician
  • Stockbridge, GA
National Provider Identifier
1447290341
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
57739 Issued in GA
Practice address
350 Country Club Dr
Suite-D
Stockbridge, GA 30281-9084
Phone
(770) 474-1919
Fax
(770) 474-7832
NPI assigned
Jun 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 57739 GA Primary

Addresses

Primary practice location

350 Country Club Dr
Suite-D
Stockbridge, GA 30281-9084

Mailing address

350 Country Club Dr
Suite-D
Stockbridge, GA 30281-9084
Phone (770) 474-1919

Other identifiers 1

IdentifierTypeStateIssuer
267388816AMedicaidGA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061002000022 GA Practitioner - Obstetrics/Gynecology 0547245169 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
57739GAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Harbor Hospital Physicians LLC Past Accepting new patients
Harbor Hospital Past Accepting new patients

Organizations & group practices 3

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": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317859200000",
    "number": "1447290341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 COUNTRY CLUB DR",
            "address_2": "SUITE-D",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819084",
            "telephone_number": "770-474-1919",
            "fax_number": "770-474-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 COUNTRY CLUB DR",
            "address_2": "SUITE-D",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819084",
            "telephone_number": "770-474-1919",
            "fax_number": "770-474-7832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "AMANDA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2011-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "57739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267388816A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

Verify at the official NPI Registry.