Provider Demographics
NPI:1619189784
Name:PUETT, PAMELA T (CNM)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:T
Last Name:PUETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 HIGHWAY 54 W STE 220
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4552
Mailing Address - Country:US
Mailing Address - Phone:770-991-2200
Mailing Address - Fax:
Practice Address - Street 1:1279 HIGHWAY 54 W STE 220
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4552
Practice Address - Country:US
Practice Address - Phone:770-991-2200
Practice Address - Fax:770-991-1341
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089764363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology