Provider Demographics
NPI:1942251129
Name:VICK-BOPE, PAMELA GALE (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:GALE
Last Name:VICK-BOPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:GALE
Other - Last Name:VICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:404-677-7340
Practice Address - Street 1:2400 MOUNT ZION PARKWAY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:404-677-6304
Practice Address - Fax:404-677-7340
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001016207L00000X
GA057855208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891262AMedicaid
NC2280843Medicare ID - Type Unspecified
GA05BDLFHMedicare PIN
NC891262AMedicaid
G48829Medicare UPIN
NCG48829Medicare UPIN