Healthcare Provider Details

I. General information

NPI: 1326984865
Provider Name (Legal Business Name): PAMELA WHITE-NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 US HIGHWAY 80 W STE I
POOLER GA
31322-2198
US

IV. Provider business mailing address

1850 BENTON BLVD UNIT 4210
SAVANNAH GA
31407-1175
US

V. Phone/Fax

Practice location:
  • Phone: 203-997-9058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number015451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: