Provider Demographics
NPI:1174051593
Name:BANKS, PAMELA ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:ELIZABETH
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3700 FL SHUTTLESWORTH DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35207-3044
Mailing Address - Country:US
Mailing Address - Phone:205-222-3080
Mailing Address - Fax:205-841-9568
Practice Address - Street 1:3700 FL SHUTTLESWORTH DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-3044
Practice Address - Country:US
Practice Address - Phone:205-222-3089
Practice Address - Fax:205-841-9568
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL170205061744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management