Provider Demographics
NPI:1194244731
Name:PINCKNEY, PAMELA ELDER
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELDER
Last Name:PINCKNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LONGMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-5373
Mailing Address - Country:US
Mailing Address - Phone:678-682-0415
Mailing Address - Fax:
Practice Address - Street 1:179 HANDLEY RD STE D8
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2152
Practice Address - Country:US
Practice Address - Phone:404-819-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional