Provider Demographics
NPI:1427018068
Name:ASADI, PAMELA L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:L
Last Name:ASADI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2914
Mailing Address - Country:US
Mailing Address - Phone:253-761-0573
Mailing Address - Fax:
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 150A
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4357
Practice Address - Country:US
Practice Address - Phone:770-509-1025
Practice Address - Fax:770-509-1884
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003523171000000X
GA007051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003141244GMedicaid
GA003141244FMedicaid
GA003141244HMedicaid
GA003141244EMedicaid