Individual provider Active NPI

Amanda Butler, FNP-C

  • Family Nurse Practitioner
  • McDonough, GA
National Provider Identifier
1639578305
Registry record updated Aug 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN155412 Issued in GA
Practice address
2200 Highway 155 N
McDonough, GA 30252-4846
Phone
(678) 490-0341
Fax
(678) 490-0349
NPI assigned
Aug 19, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN155412 GA Primary

Addresses

Primary practice location

2200 Highway 155 N
McDonough, GA 30252-4846

Mailing address

2200 Highway 155 N
McDonough, GA 30252-4846
Phone (678) 490-0341

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
I20141107001693 GA Practitioner - Nurse Practitioner 4688896558 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN155412GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Family Care LLC CurrentSince May 20, 2019 Accepting new patients
East Metro Rheumatology LLC PastSince May 20, 2019 Accepting new patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients

Locations

1775 Access Rd
Ste C
Covington, GA 30014
Phone (678) 729-0003

Organizations & group practices 5

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": "1408406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408406400000",
    "number": "1639578305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 HIGHWAY 155 N",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302524846",
            "telephone_number": "678-490-0341",
            "fax_number": "678-490-0349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HIGHWAY 155 N",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302524846",
            "telephone_number": "678-490-0341",
            "fax_number": "678-490-0349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "AMANDA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-19",
        "last_updated": "2014-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN155412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, GA

Sources for this page

Verify at the official NPI Registry.