| Pamela Nicole Dallas, | |
|
3462 Ashford Loop, Ellenwood, GA 30294-3674 | |
| (770) 364-2666 | |
| Not Available |
| Full Name | Pamela Nicole Dallas |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 3462 Ashford Loop, Ellenwood, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770247066 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163WM0102X | Registered Nurse - Maternal Newborn | RN242295 (Georgia) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | RN242295 (Georgia) | Primary |
| Entity Name | Piedmont Medical Care Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912956046 PECOS PAC ID: 6002802220 Enrollment ID: O20040422001500 |
| Mailing Address | Practice Location Address |
|---|---|
| Pamela Nicole Dallas, 3462 Ashford Loop, Ellenwood, GA 30294-3674 Ph: () - | Pamela Nicole Dallas, 3462 Ashford Loop, Ellenwood, GA 30294-3674 Ph: (770) 364-2666 |
Sharalyn Marrion Martin, NP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 209 Saint Lukes Way, Ellenwood, GA 30294 Phone: 678-520-1616 | |
Jacqueline Lewis, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 304 Summit Heights Ct Ste 120, Ellenwood, GA 30294 Phone: 404-552-5128 | |
Ms. Abosede Haygood, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 4639 River Hill Cir, Ellenwood, GA 30294 Phone: 404-259-0967 | |
Ngassa Nchapada Menga Faith, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 2568 Brittany Park Cv, Ellenwood, GA 30294 Phone: 404-578-5437 | |
Rose Senge Kombe, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 211 Fairview Rd, Ellenwood, GA 30294 Phone: 678-289-6747 Fax: 678-289-6750 | |
Shalundrah Mcintire, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4475 W Village Pkwy, Ellenwood, GA 30294 Phone: 770-507-7950 Fax: 716-710-8082 | |
Mrs. Terrilyn D Lemons, APRNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 4018 Park Place Cir, Ellenwood, GA 30294 Phone: 404-212-1024 Fax: 404-212-1024 |