Provider Demographics
NPI:1689101479
Name:DUGAR, PAMELA OLIVIA
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:OLIVIA
Last Name:DUGAR
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 1:3117 DEANS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3379
Mailing Address - Country:US
Mailing Address - Phone:706-821-1155
Mailing Address - Fax:706-821-2907
Practice Address - Street 1:3117 DEANS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3379
Practice Address - Country:US
Practice Address - Phone:706-821-1155
Practice Address - Fax:706-821-2907
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121-01146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate