Provider Demographics
NPI:1023410586
Name:PHAM, CHARMAINE QUIRIMIT (NP)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:QUIRIMIT
Last Name:PHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:459 HIGHWAY 119 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-3021
Mailing Address - Country:US
Mailing Address - Phone:912-754-0175
Mailing Address - Fax:912-754-6395
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-355-6615
Practice Address - Fax:912-351-0645
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA203691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1023410586Medicaid