Pamela Nicole Dallas

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN242295 Issued in GA

Practice address

3462 Ashford Loop
Ellenwood, GA 30294-3674

Phone

(770) 364-2666

NPI assigned

Oct 24, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Piedmont Medical Care Corporation

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1912956046
  Medicare reassignment NPD

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

{
    "created_epoch": "1635033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1770247066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3462 ASHFORD LOOP",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302943674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3462 ASHFORD LOOP",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302943674",
            "telephone_number": "770-364-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLAS",
        "first_name": "PAMELA",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-24",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "GA",
            "license": "RN242295",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN242295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Solia Crigler
• Anissa J Crimley
• Shannon Lynette Crosslin
• Crown Couture Solutions LLC
• Kristal Cure
• Larita Patrice Dalton
• Damate Healthcare Services, Inc
• Gaea Anita Daniel, PHD, RN
• Kelsey Mims Daniels, DPT
• Andrew Benjamin Davis, PHD

• Family Nurse Practitioner in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.