Provider Demographics
NPI:1669252748
Name:JIMSON, PAMELA RENEA (MHA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEA
Last Name:JIMSON
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 HILLSBORO PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3344
Mailing Address - Country:US
Mailing Address - Phone:844-754-3729
Mailing Address - Fax:
Practice Address - Street 1:510 SOUTHLAKE DR
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2669
Practice Address - Country:US
Practice Address - Phone:662-822-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20-002PI19202K00000X
MS20-002P19246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy