Doctor Name: | DR. PAMELA GROSS |
NPI Number: | 1689867814 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 042589 |
Business Practice Address: | 219 Missionary Dr Decatur, GA - 300303842 |
Business Phone Number: | 4043291085 |
Business Fax Number: | |
Mailing Address: | 219 Missionary Dr, DECATUR |
State: | GA |
Postal Code: | 300303842 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/21/2007 |
NPI Last Update Date: | 08/31/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 042589 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |