Provider Demographics
NPI:1902541527
Name:MCINTYRE, PAMILA SHELTON (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:PAMILA
Middle Name:SHELTON
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:MRS
Other - First Name:PAMILA
Other - Middle Name:DELORES SHELTON
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:A-GNP-C
Mailing Address - Street 1:612 PIEDMONT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-2800
Mailing Address - Country:US
Mailing Address - Phone:706-599-9218
Mailing Address - Fax:
Practice Address - Street 1:189 BO JAMES ST STE 105
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-6199
Practice Address - Country:US
Practice Address - Phone:706-782-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249566363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology