Provider Demographics
NPI:1780605295
Name:LOVE, PAMELA R (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:LOVE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N POINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4102
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:
Practice Address - Street 1:544 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3230
Practice Address - Country:US
Practice Address - Phone:478-237-2527
Practice Address - Fax:478-237-7406
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085597163W00000X
GARN 085597 NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP53203Medicare UPIN
GA50BBFVKMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER