Provider Demographics
NPI:1194264481
Name:PIERCE, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PIERCE
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 1:25 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-1852
Mailing Address - Country:US
Mailing Address - Phone:229-336-7472
Mailing Address - Fax:229-584-5966
Practice Address - Street 1:25 PERRY ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1852
Practice Address - Country:US
Practice Address - Phone:229-336-7472
Practice Address - Fax:229-584-5966
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188908363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics