Provider Demographics
NPI:1184617425
Name:TINSLEY, PAMELA (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:678-797-8201
Mailing Address - Fax:678-290-8325
Practice Address - Street 1:790 CHURCH ST NE
Practice Address - Street 2:SUITE 250
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7282
Practice Address - Country:US
Practice Address - Phone:678-797-8201
Practice Address - Fax:678-290-8325
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA369645OtherWELLCARE
GAP00200438OtherRAILROAD MEDICARE
GA000936328AMedicaid
GA369645OtherWELLCARE
GAP49264Medicare UPIN