=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740366442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA H TEMPLES MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 01/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 814 NORTHWOOD PARK DR
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31602-1398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-262-6810
-----------------------------------------------------
Fax | 229-219-1634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 NORTHWOOD PARK DR
-----------------------------------------------------
City | VALDOSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31602-1398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-262-6810
-----------------------------------------------------
Fax | 229-219-1634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 053045
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------