Provider Demographics
NPI:1982801775
Name:HONEYCUTT, PAMELA LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LYNN
Last Name:HONEYCUTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:NALLY
Other - Last Name:HONEYCUTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:4588 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4911
Mailing Address - Country:US
Mailing Address - Phone:770-974-6523
Mailing Address - Fax:770-606-2110
Practice Address - Street 1:958 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2158
Practice Address - Country:US
Practice Address - Phone:770-387-8188
Practice Address - Fax:770-606-2110
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA000465225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant