Active NPI
Pamela Deramus Heard
- Adult Day Care Clinic/Center
- College Park, GA
National Provider Identifier
1376962670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Day Care Clinic/Center
- License
- 2014 NONPS-0077
- Practice address
- 5380 Somerlane TRL
College Park, GA 30349-2040 - Phone
- (678) 362-7862
- NPI assigned
- Apr 15, 2014
- Last updated
- Apr 15, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Day Care Clinic/Center | 261QA0600X | 2014 NONPS-0077 | GA | Primary |
Addresses
Primary practice location
5380 Somerlane TRL
College Park, GA 30349-2040
Mailing address
5380 Somerlane TRL
College Park, GA 30349-2040
Phone (678) 362-7862
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 189317268A | Other | GA | MEDICARE PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014 NONPS-0077 | GA | MD | Adult Day Care Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397520000000",
"number": "1376962670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5380 SOMERLANE TRL",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303492040",
"telephone_number": "678-362-7862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5380 SOMERLANE TRL",
"city": "COLLEGE PARK",
"state": "GA",
"postal_code": "303492040",
"telephone_number": "678-362-7862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERAMUS HEARD",
"first_name": "PAMELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-04-15",
"last_updated": "2014-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "261QA0600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Day Care",
"state": "GA",
"license": "2014 NONPS-0077",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER ID",
"identifier": "189317268A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in College Park, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.