Provider Demographics
NPI:1013043355
Name:MELIESTE, PAMELA K (MSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:K
Last Name:MELIESTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 HENRY CLOWER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3152
Mailing Address - Country:US
Mailing Address - Phone:770-978-9393
Mailing Address - Fax:770-978-9324
Practice Address - Street 1:2301 HENRY CLOWER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3152
Practice Address - Country:US
Practice Address - Phone:770-978-9393
Practice Address - Fax:770-978-9324
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003196104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBGPJMedicare PIN