Healthcare Provider Details

I. General information

NPI: 1881818862
Provider Name (Legal Business Name): PAMELA TOMBERLIN STONE I R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W MAIN ST
LAKELAND GA
31635-1421
US

IV. Provider business mailing address

421 W MAIN ST
LAKELAND GA
31635-1419
US

V. Phone/Fax

Practice location:
  • Phone: 229-482-8164
  • Fax: 229-482-1074
Mailing address:
  • Phone: 229-482-8164
  • Fax: 229-482-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN115881
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN115881
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: