Provider Demographics
NPI:1447827811
Name:AMANDA D DYER, PHD, INC
Entity type:Organization
Organization Name:AMANDA D DYER, PHD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-410-4074
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0024
Mailing Address - Country:US
Mailing Address - Phone:706-410-4074
Mailing Address - Fax:706-664-0459
Practice Address - Street 1:47 GREENSBORO HWY STE 3
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2515
Practice Address - Country:US
Practice Address - Phone:706-410-4074
Practice Address - Fax:706-664-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health