Organization
PMR RETAILER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA MECHELLE RUSSELL AAS, OVC/NOVA (OWNER)
(470) 205-9882
Entity
Organization
Contact information
Practice address
13 RAY RD, COVINGTON, GA 30014-5954
(470) 205-9882
Mailing address
13 RAY RD, COVINGTON, GA 30014-5954
(470) 205-9882
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251X00000X
Supports Brokerage Agency
Primary
—
—
Other
Enumeration date
04/14/2026
Last updated
04/14/2026
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