Individual provider Active NPI

Pamela Gresham Pomar, NP

  • Pediatric Nurse Practitioner
  • Austell, GA
National Provider Identifier
1730279555
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN054213 Issued in GA
Practice address
393 Maxham Rd Ste a&B
Austell, GA 30168-5539
Phone
(770) 732-6007
Fax
(770) 732-8242
NPI assigned
Oct 13, 2006
Last updated
Sep 23, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN054213 GA Primary

Addresses

Primary practice location

393 Maxham Rd Ste a&B
Austell, GA 30168-5539

Mailing address

393 Maxham Rd Ste a&B
Austell, GA 30168-5539
Phone (770) 732-6007

Other identifiers 2

IdentifierTypeStateIssuer
RN054213OtherGANURSING LICENSE
685604753CMedicaidGA

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
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN054213GAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nuestros Ninos Our Kids Pediatrics PC Pediatrics Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1730279555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 MAXHAM RD STE A&B",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301685539",
            "telephone_number": "770-732-6007",
            "fax_number": "770-732-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 MAXHAM RD STE A&B",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301685539",
            "telephone_number": "770-732-6007",
            "fax_number": "770-732-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POMAR",
        "first_name": "PAMELA",
        "middle_name": "GRESHAM",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN054213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING LICENSE",
            "identifier": "RN054213",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "685604753C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.