Basic Information
Provider Information
NPI: 1962821108
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOPKINS
FirstName: AMANDA
MiddleName: NICOLE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3104 BLUE LAKE DR STE 110
Address2:  
City: VESTAVIA
State: AL
PostalCode: 352432372
CountryCode: US
TelephoneNumber: 2059771949
FaxNumber: 2059771933
Practice Location
Address1: 3104 BLUE LAKE DR STE 110
Address2:  
City: VESTAVIA
State: AL
PostalCode: 352432372
CountryCode: US
TelephoneNumber: 2059771949
FaxNumber: 2059771933
Other Information
ProviderEnumerationDate: 04/15/2014
LastUpdateDate: 06/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LC0200XMD.38349ALY Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine

No ID Information.


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