Provider Demographics
NPI:1568554632
Name:ABERNATHY, PAMELA S (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 CHATSWORTH HIGHWAY 225 NE
Mailing Address - Street 2:
Mailing Address - City:RESACA
Mailing Address - State:GA
Mailing Address - Zip Code:30735-6536
Mailing Address - Country:US
Mailing Address - Phone:706-629-8750
Mailing Address - Fax:
Practice Address - Street 1:1104 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2588
Practice Address - Country:US
Practice Address - Phone:706-226-5533
Practice Address - Fax:706-428-0033
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR107241NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00941696AMedicaid
GA797349OtherBCBS EDI NUMBER
GA797349OtherBCBS EDI NUMBER
GAP56943Medicare UPIN