Healthcare Provider Details

I. General information

NPI: 1003083528
Provider Name (Legal Business Name): PAMELIA JAYNE CROWDER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 COBB PKWY NW
ACWORTH GA
30101-8320
US

IV. Provider business mailing address

6199 HIGHWAY 92 STE 176
ACWORTH GA
30102-2346
US

V. Phone/Fax

Practice location:
  • Phone: 770-975-8776
  • Fax: 770-975-4326
Mailing address:
  • Phone: 770-924-9105
  • Fax: 770-926-4827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number021239
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: