Healthcare Provider Details

I. General information

NPI: 1588990816
Provider Name (Legal Business Name): PAMELA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 N EUGENIA PL NW
ATLANTA GA
30318-4867
US

IV. Provider business mailing address

936 N EUGENIA PL NW
ATLANTA GA
30318-4867
US

V. Phone/Fax

Practice location:
  • Phone: 770-765-7458
  • Fax:
Mailing address:
  • Phone: 610-363-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCSW009667
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: