Healthcare Provider Details

I. General information

NPI: 1265526842
Provider Name (Legal Business Name): PAMELA S GEWIRTZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ATLANTA HWY
WINDER GA
30024
US

IV. Provider business mailing address

440 ATLANTA HWY NW
WINDER GA
30680-7826
US

V. Phone/Fax

Practice location:
  • Phone: 770-868-5992
  • Fax: 770-868-1466
Mailing address:
  • Phone: 770-868-5992
  • Fax: 770-868-1466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1756
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: