Provider Demographics
NPI:1447440110
Name:MUNDALE, PAMELA H (DC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:H
Last Name:MUNDALE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:MUNDALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2531 BRIARCLIFF RD NE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3017
Mailing Address - Country:US
Mailing Address - Phone:404-248-1180
Mailing Address - Fax:
Practice Address - Street 1:2531 BRIARCLIFF RD NE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3017
Practice Address - Country:US
Practice Address - Phone:404-248-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor