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NPI Code Detail

MEDICARE: PAMILA SHELTON MCINTYRE A-GNP-C

MEDICARE: PAMILA SHELTON MCINTYRE A-GNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerRN249566GA
2363LG0600XGerontology Nurse PractitionerRN249566GA
3363L00000XNurse PractitionerRN249566GA

General Provider Information

NPI Number : 1902541527
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMILA SHELTON MCINTYRE A-GNP-C
Provider Business Mailing Address
First Line : 612 PIEDMONT MOUNTAIN RD
Second Line :
City : CLARKESVILLE
State : GA
Zip : 30523-2800
Country : US
Telephone Number : 706-599-9218
Fax Number :
Provider Business Practice Location Address
First Line : 189 BO JAMES ST STE 105
Second Line :
City : CLAYTON
State : GA
Zip : 30525-6199
Country : US
Telephone Number : 706-782-0016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2022
Last Update Date : 04/28/2022

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