Provider Demographics
NPI:1053555359
Name:HOSTETTER, AMY LEE (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEE
Last Name:HOSTETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:115 VICKERY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4977
Mailing Address - Country:US
Mailing Address - Phone:678-883-6096
Mailing Address - Fax:678-373-3330
Practice Address - Street 1:115 VICKERY ST STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4977
Practice Address - Country:US
Practice Address - Phone:678-883-6096
Practice Address - Fax:678-373-3330
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA692242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty