Healthcare Provider Details

I. General information

NPI: 1629087465
Provider Name (Legal Business Name): PAMELLA PETRINA CHARLES-PRYCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STEVE REYNOLDS BLVD KAISER PERMANENTE GWINNETT MEDICAL CENTER
DULUTH GA
30096-4506
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 770-931-6012
  • Fax: 770-806-1383
Mailing address:
  • Phone: 404-364-7070
  • Fax: 770-806-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number058155
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number05B155
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: