1336399872 NPI number — MRS. PAMELA BUCKLEY ROBERSON APRN, CNSPMH

Table of content: MRS. PAMELA BUCKLEY ROBERSON APRN, CNSPMH (NPI 1336399872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336399872 NPI number — MRS. PAMELA BUCKLEY ROBERSON APRN, CNSPMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERSON
Provider First Name:
PAMELA
Provider Middle Name:
BUCKLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNSPMH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336399872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 MORALLION HLS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEACHTREE CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30269-2769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-487-2913
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 JESSE HILL JR DR SE
Provider Second Line Business Practice Location Address:
13 TH FLOOR PES
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30303-3031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-3330
Provider Business Practice Location Address Fax Number:
404-616-4766
Provider Enumeration Date:
09/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  RN073844 CNS/PMH , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com