Provider Demographics
NPI:1447257811
Name:SALAZAR, PAMELA BARBER (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:BARBER
Last Name:SALAZAR
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 1:630 13TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1015
Mailing Address - Country:US
Mailing Address - Phone:706-722-1244
Mailing Address - Fax:706-722-6566
Practice Address - Street 1:630 13TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1015
Practice Address - Country:US
Practice Address - Phone:706-722-1244
Practice Address - Fax:706-722-6566
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044834208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00774012CMedicaid
GA216760OtherBCBS
SCG44834Medicaid
5590519OtherAETNA
GA00774012CMedicaid
SCG44834Medicaid