Provider Demographics
NPI:1861517294
Name:QUALLS, PAMELA ROSE (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ROSE
Last Name:QUALLS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 H R HUFFER RD
Mailing Address - Street 2:
Mailing Address - City:ALLONS
Mailing Address - State:TN
Mailing Address - Zip Code:38541
Mailing Address - Country:US
Mailing Address - Phone:623-606-7347
Mailing Address - Fax:931-262-2035
Practice Address - Street 1:550 H R HUFFER RD
Practice Address - Street 2:
Practice Address - City:ALLONS
Practice Address - State:TN
Practice Address - Zip Code:38541
Practice Address - Country:US
Practice Address - Phone:602-568-9816
Practice Address - Fax:931-262-2035
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0118176B00000X
TN121176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife