Provider Demographics
NPI:1740236470
Name:GAUDRY, PAMELA GALLUP (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:GALLUP
Last Name:GAUDRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:G
Other - Last Name:GALLUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-5937
Mailing Address - Fax:912-350-3483
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-5937
Practice Address - Fax:912-350-3483
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033966207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000539646EMedicaid
GA624523OtherWELLCARE
GA10065376OtherAMERIGROUP
GA160051160OtherRR MEDICARE
GA000539646CMedicaid
GA349768OtherWELLCARE
GA000539646FMedicaid
SCG33966Medicaid
GA000539646FMedicaid
GA000539646EMedicaid