Individual
PAMELA DERAMUS HEARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5380 SOMERLANE TRL, COLLEGE PARK, GA 30349-2040
(678) 362-7862
Mailing address
5380 SOMERLANE TRL, COLLEGE PARK, GA 30349-2040
(678) 362-7862
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
2014 NONPS-0077
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
189317268A
MEDICARE PROVIDER ID
GA
Enumeration date
04/15/2014
Last updated
04/15/2014
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