Provider Demographics
NPI:1982807780
Name:WILLIAMS, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:EPPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:204 TYLER TRCE
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-8786
Mailing Address - Country:US
Mailing Address - Phone:678-446-2381
Mailing Address - Fax:770-233-6216
Practice Address - Street 1:204 TYLER TRCE
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-8786
Practice Address - Country:US
Practice Address - Phone:678-446-2381
Practice Address - Fax:770-233-6216
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator