Basic Information
| Provider Information | |||||||||
| NPI: | 1447251459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERDMAN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5364 OXBOW RD | ||||||||
| Address2: | |||||||||
| City: | STONE MOUNTAIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300871227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709381757 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 NORTHLAKE PKWY | ||||||||
| Address2: | STE 280 | ||||||||
| City: | TUCKER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300844022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709381757 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 028960 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00361567A | 05 | GA | MEDICAID |