Provider Demographics
NPI:1174528079
Name:SMITH, PAMELA GOBER (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:GOBER
Last Name:SMITH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1742 CRABAPPLE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:GA
Mailing Address - Zip Code:30646-2811
Mailing Address - Country:US
Mailing Address - Phone:706-540-6303
Mailing Address - Fax:
Practice Address - Street 1:220 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2738
Practice Address - Country:US
Practice Address - Phone:706-583-2777
Practice Address - Fax:706-369-6374
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN045170363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health