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General NPI Number Information
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NPI Number | 1558782474
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Entity Type | Organization
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Legal Business Name | PEMBERTON & ASSOCIATES
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 2253 ALLEGHENY LN
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City | WATKINSVILLE
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State | GA
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Zip | 30677-8347
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Country | US
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Telephone | 770-725-9271
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Fax | 770-725-2985
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Provider Business Mailing Address
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Address Line | 2253 ALLEGHENY LN
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City | WATKINSVILLE
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State | GA
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Zip | 30677-8347
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Country | US
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Telephone | 770-725-9271
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Fax | 770-725-2985
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Authorized Official
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Title or Position | CEO
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Name | MR. GREGORY A PEMBERTON
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Credential | PT/OTR
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Telephone | 770-725-9271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT000620
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT002327
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License Number State | GA
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