Provider Demographics
NPI:1992845499
Name:COLLMAN, PAMELA BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:BETH
Last Name:COLLMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:912-756-7686
Mailing Address - Fax:912-756-7856
Practice Address - Street 1:3766 HWY 17
Practice Address - Street 2:STE 104
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-756-7686
Practice Address - Fax:912-756-7856
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002520103G00000X, 103TC0700X, 103TC2200X
CAPSY16357103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA478168OtherVALUE OPTIONS SOUTH WEST
GA899577937BMedicaid
CAOPL163570Medicare ID - Type Unspecified
GA899577937BMedicaid