Gerrald, Amanda

Gerrald, Amanda is an individual health care provider with primary practice located at 1608 Main St , Conway SC 29526-3572. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Gerrald, Amanda can be contacted via phone (843) 248-4700.

Contact Information

Primary practice address
1608 Main St Conway SC 29526-3572
Phone: (843) 248-4700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 18893 South Carolina

Profile Details

NPI number 1144637166
LBN Legal business name Gerrald, Amanda
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2014
Last updated Dec 22nd, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144637166 NPPES
South Carolina MEDICAID NP3725

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