Individual
GREGORY A PEMBERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT AND OTR
Contact information
Practice address
2253 ALLEGHENY LANE, WATKINSVILLE, GA 30677-8347
(678) 753-1135
(678) 753-1173
Mailing address
2253 ALLEGHENY LANE, WATKINSVILLE, GA 30677-8347
(678) 753-1135
(678) 753-1173
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT002327
GA
225X00000X
Occupational Therapist
OT000620
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000692546B
—
GA
05
—
000692546C
—
GA
Enumeration date
04/11/2007
Last updated
04/30/2025
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