Provider Demographics
NPI:1255820866
Name:NELSON, PAMELA HOOD
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:HOOD
Last Name:NELSON
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 1:1985 TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-1635
Mailing Address - Country:US
Mailing Address - Phone:229-869-4308
Mailing Address - Fax:
Practice Address - Street 1:1985 TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:CONLEY
Practice Address - State:GA
Practice Address - Zip Code:30288-1635
Practice Address - Country:US
Practice Address - Phone:229-869-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor