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1558782474 NPI number — PEMBERTON & ASSOCIATES

NPI Number: 1558782474
Health Care Provider/Practitioner: PEMBERTON & ASSOCIATES

Information about “1558782474” NPI (PEMBERTON & ASSOCIATES) exists in 1558782474 in HTML format HTML  |  1558782474 in plain Text format TXT  |  1558782474 in PDF (Portable Document Format) PDF  |  1558782474 in an XML format XML  formats.

NPI Number : 1558782474 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558782474",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PEMBERTON & ASSOCIATES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2253 ALLEGHENY LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WATKINSVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30677-8347",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-725-9271",
    "MailingAddressFaxNumber": "770-725-2985",
    "FirstLinePracticeLocationAddress": "2253 ALLEGHENY LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATKINSVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30677-8347",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-725-9271",
    "PracticeLocationAddressFaxNumber": "770-725-2985",
    "EnumerationDate": "12/18/2013",
    "LastUpdateDate": "12/18/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PEMBERTON",
    "AuthorizedOfficialFirstName": "GREGORY",
    "AuthorizedOfficialMiddleName": "A",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PT/OTR",
    "AuthorizedOfficialTelephoneNumber": "770-725-9271",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225X00000X",
          "TaxonomyName": "Occupational Therapist",
          "LicenseNumber": "OT000620",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "PT002327",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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