Provider Demographics
NPI:1548591605
Name:WILLIAMS, PAMELA CLARK (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:CLARK
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SUMMER HILL WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5652
Mailing Address - Country:US
Mailing Address - Phone:706-360-5422
Mailing Address - Fax:706-432-3780
Practice Address - Street 1:1915 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5098
Practice Address - Country:US
Practice Address - Phone:912-356-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA160049363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606317BMedicaid
GA000606317BMedicaid