Provider Demographics
NPI:1013213453
Name:DANIEL, PAMELA ANNETTE
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANNETTE
Last Name:DANIEL
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 1:6660 MABLETON PKWY SE APT 608
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5342
Mailing Address - Country:US
Mailing Address - Phone:678-477-3037
Mailing Address - Fax:
Practice Address - Street 1:6660 MABLETON PKWY SE APT 608
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-5342
Practice Address - Country:US
Practice Address - Phone:678-477-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA27-4731933OtherEIN