Provider Demographics
NPI:1679707186
Name:BROWN, PAMELA JEAN
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:BROWN
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 1:1258 DEKALB AVE NE
Mailing Address - Street 2:#114
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-5115
Mailing Address - Country:US
Mailing Address - Phone:404-695-6247
Mailing Address - Fax:
Practice Address - Street 1:1258 DEKALB AVE NE
Practice Address - Street 2:#114
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-5115
Practice Address - Country:US
Practice Address - Phone:404-695-6247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN084599NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily