MEDICARE: PAMELA REID SELDON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW007188	GA

General Provider Information

NPI Number	:	1487265856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA REID SELDON LCSW

Provider Business Mailing Address
First Line	:	2022 15TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1608
Country	:	US
Telephone Number	:	706-649-6500
Fax Number	:	706-649-6521

Provider Business Practice Location Address
First Line	:	3100 GENTIAN BLVD STE 22B
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-5670
Country	:	US
Telephone Number	:	706-358-4141
Fax Number	:	706-358-4141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	10/01/2024

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