Basic Information
| Provider Information | |||||||||
| NPI: | 1821018607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POMERLEAU | ||||||||
| FirstName: | RAYMOND | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 AMBULANCE DR | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173865 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 7708369261 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 W LYON ST | ||||||||
| Address2: | |||||||||
| City: | TALLAPOOSA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301761288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708242824 | ||||||||
| FaxNumber: | 7708242810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 024476 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.