Provider Demographics
NPI:1447251459
Name:ERDMAN, PAMELA K (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:K
Last Name:ERDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5364 OXBOW RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1227
Mailing Address - Country:US
Mailing Address - Phone:770-938-1757
Mailing Address - Fax:
Practice Address - Street 1:2200 NORTHLAKE PKWY
Practice Address - Street 2:STE 280
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4022
Practice Address - Country:US
Practice Address - Phone:770-938-1757
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028960207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00361567AMedicaid
GA00361567AMedicaid