Healthcare Provider Details

I. General information

NPI: 1255414793
Provider Name (Legal Business Name): MRS. PAMELA G MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E. MAIN STREET
BRONWOOD GA
39826
US

IV. Provider business mailing address

302 MERCER STREET P.O. BOX 121
BRONWOOD GA
39826
US

V. Phone/Fax

Practice location:
  • Phone: 229-669-6879
  • Fax:
Mailing address:
  • Phone: 229-995-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: