Provider Demographics
NPI:1508341231
Name:BYNUM-DOLES, PAMELA SONIA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SONIA
Last Name:BYNUM-DOLES
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 1:716 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-2102
Mailing Address - Country:US
Mailing Address - Phone:757-642-4393
Mailing Address - Fax:
Practice Address - Street 1:716 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2102
Practice Address - Country:US
Practice Address - Phone:757-642-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2631310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility