Pamela Boudrey
Individual provider Active NPI Contractor · Covington, GA
NPI 1013717438 · NPPES record last updated Mar 14, 2025
Key facts
- NPI
- 1013717438
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 10 Breckonridge Dr
Covington, GA 30016-2506 - Phone
- (678) 558-3524
- NPI assigned
- Mar 14, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | GA | Yes |
Addresses
Primary practice location
10 Breckonridge Dr
Covington, GA 30016-2506
Mailing address
10 Breckonridge Dr
Covington, GA 30016-2506
Phone (678) 558-3524
Other providers in Covington, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.