Basic Information
| Provider Information | |||||||||
| NPI: | 1427018068 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASADI | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 N BENNETT ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984062914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537610573 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4800 OLDE TOWNE PKWY STE 150A | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300684357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705091025 | ||||||||
| FaxNumber: | 7705091884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 10/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | PA10003523 | WA | N | Other Service Providers | Military Health Care Provider | 363A00000X | 007051 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 003141244G | 05 | GA | MEDICAID | 003141244F | 05 | GA | MEDICAID | 003141244H | 05 | GA | MEDICAID | 003141244E | 05 | GA | MEDICAID |