Healthcare Provider Details

I. General information

NPI: 1548197056
Provider Name (Legal Business Name): PAMELA JEMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 STORY RAY DR
NEW MARKET AL
35761-6500
US

IV. Provider business mailing address

171 STORY RAY DR
NEW MARKET AL
35761-6500
US

V. Phone/Fax

Practice location:
  • Phone: 804-835-0717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number50132
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: