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General NPI Number Information
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NPI Number | 1558783498
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Entity Type | Individual
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Provider Name | PAMELA SUZANNE MALO PTA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 5131 WARM SPRINGS RD
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City | COLUMBUS
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State | GA
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Zip | 31909-4196
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Country | US
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Telephone | 706-561-1371
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E STATE ST
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-3109
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Country | US
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Telephone | 610-444-6350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 002808
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License Number State | GA
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