Healthcare Provider Details

I. General information

NPI: 1124331640
Provider Name (Legal Business Name): PAMELA PIERCE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 06/02/2023
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 WOODMONT LN NW #4497
ATLANTA GA
30318-2866
US

IV. Provider business mailing address

1445 WOODMONT LN NW # 4497
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 470-615-1529
  • Fax:
Mailing address:
  • Phone: 470-615-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN210418
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN210418
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN210418
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: