MEDICARE: PAMELA MECHELLE RUSSELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		GA
2	171M00000X	Case Manager/Care Coordinator		GA

General Provider Information

NPI Number	:	1194668731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MECHELLE RUSSELL

Provider Business Mailing Address
First Line	:	13 RAY RD
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-5954
Country	:	US
Telephone Number	:	470-456-2143
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 RAY RD
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-5954
Country	:	US
Telephone Number	:	470-456-2143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “ PAMELA MECHELLE RUSSELL ” Practice Location

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