Provider Demographics
NPI:1205881802
Name:SNYDER, TAMELA MILES (MD)
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:MILES
Last Name:SNYDER
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:PO BOX 491028
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0053
Mailing Address - Country:US
Mailing Address - Phone:404-605-3247
Mailing Address - Fax:770-237-1920
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-3247
Practice Address - Fax:404-609-6645
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1359207ZP0102X
GA059964207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182702401Medicaid
GAP00697817Medicare PIN
TX8F3004Medicare ID - Type Unspecified
I52744Medicare UPIN
GA511I220007Medicare PIN