Individual provider Active NPI

Pamela Clark Williams, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Savannah, GA
National Provider Identifier
1548591605
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
160049 Issued in GA
Practice address
1915 Eisenhower Dr
Savannah, GA 31406-5098
Phone
(912) 356-2011
NPI assigned
Jan 28, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 160049 GA Primary

Addresses

Primary practice location

1915 Eisenhower Dr
Savannah, GA 31406-5098

Mailing address

310 Summer Hill Way
Richmond Hill, GA 31324-5652
Phone (706) 360-5422

Other identifiers 1

IdentifierTypeStateIssuer
000606317BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180821003968 GA Practitioner - Nurse Practitioner 8628332939 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Daniel Perry LLCGroup PAC ID 7012402522, 2 clinicians

Practice addresses (Care Compare)

315 Commercial Dr
Suite D6
Savannah, GA 31406-3645
Phone (404) 719-1665

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
160049GAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Behavioral Health and Developmental Disabilities CurrentSince Jun 16, 2018 Accepting new patients
Department of Behavioral Health & Developmental Disabilities, Ga CurrentSince Jun 16, 2018 Accepting new patients
Department of Behavioral Health and Developmental Disabilities Current Accepting new patients
Personal Recovery Network LLC CurrentSince Feb 15, 2021 Accepting new patients

Locations

3633 Wheeler Rd
Ste 365
Augusta, GA 30909
Phone (706) 432-6866

3405 Old Savannah Rd
Augusta, GA 30906
Phone (705) 790-2030

4039 Gateway Blvd
Grovetown, GA 30813
Phone (706) 498-9570

1915 Eisenhower Dr
Savannah, GA 31406
Phone (912) 356-2011

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1548591605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 SUMMER HILL WAY",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313245652",
            "telephone_number": "706-360-5422",
            "fax_number": "706-432-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 EISENHOWER DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314065098",
            "telephone_number": "912-356-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "PAMELA",
        "middle_name": "CLARK",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-28",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "160049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000606317B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.