Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Amanda Boulos

Individual provider Physician Assistant · NPI 1194503722

Amanda Boulos is a Physician Assistant in Marietta, Georgia. Qualified in 2024, 2 years ago. Practices with Advanced Urology Institute of Georgia, a 56-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
2
Licensed in
GA
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

1371 Church Street Ext NE Ste 200
Marietta, GA 30060-7913
Phone: (678) 481-0579
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 12976 (GA)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1194503722
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 15, 2023
Last updated in NPPESApril 28, 2025
Certification dateApril 28, 2025
Mailing address1551 Janmar Rd, Snellville, GA 30078-5606

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Advanced Urology Institute Of Georgia — 56 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Marietta