MEDICARE: PAMELA GRESHAM POMAR NP

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	363LP0200X	Pediatric Nurse Practitioner	RN054213	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RN054213	OTHER	GA	NURSING LICENSE

General Provider Information

NPI Number	:	1730279555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA GRESHAM POMAR NP

Provider Business Mailing Address
First Line	:	393 MAXHAM RD STE A&B
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-5539
Country	:	US
Telephone Number	:	770-732-6007
Fax Number	:	770-732-8242

Provider Business Practice Location Address
First Line	:	393 MAXHAM RD STE A&B
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-5539
Country	:	US
Telephone Number	:	770-732-6007
Fax Number	:	770-732-8242

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/23/2008

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