Provider Demographics
NPI:1497047518
Name:COLEMON, PAMELA G (LPN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:G
Last Name:COLEMON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 POWERS FERRY RD
Mailing Address - Street 2:BLDG 7, STE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5491
Mailing Address - Country:US
Mailing Address - Phone:770-988-9200
Mailing Address - Fax:770-988-9296
Practice Address - Street 1:1640 POWERS FERRY RD
Practice Address - Street 2:BLDG 7, STE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-988-9200
Practice Address - Fax:770-988-9296
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0749164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse