Provider Demographics
NPI:1902253750
Name:PAMPHILE, MONIQUE (LAC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:PAMPHILE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 ARBOR GATES DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5618
Mailing Address - Country:US
Mailing Address - Phone:404-384-0679
Mailing Address - Fax:
Practice Address - Street 1:550 PHARR RD NE
Practice Address - Street 2:SUITE 410
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3428
Practice Address - Country:US
Practice Address - Phone:770-568-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist