Healthcare Provider Details

I. General information

NPI: 1649089681
Provider Name (Legal Business Name): PAMELA L BUZIBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA LINDSAY OWOMUGISHA

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 MCGINNIS FERRY RD APT 1923A
SUWANEE GA
30024-8418
US

IV. Provider business mailing address

4021 MCGINNIS FERRY RD APT 1923A
SUWANEE GA
30024-8418
US

V. Phone/Fax

Practice location:
  • Phone: 803-552-4092
  • Fax:
Mailing address:
  • Phone: 803-552-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: