Provider Demographics
NPI:1295385276
Name:NELOME, PAMELA FELICIA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:FELICIA
Last Name:NELOME
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 1:2074 RESERVE PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7433
Mailing Address - Country:US
Mailing Address - Phone:470-261-3881
Mailing Address - Fax:
Practice Address - Street 1:709 BREEDLOVE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2055
Practice Address - Country:US
Practice Address - Phone:678-635-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191868363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health