Individual
JAMES PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1400 LIVE OAK LN BLDG 100, WATKINSVILLE, GA 30677
(706) 395-5525
(706) 546-8792
Mailing address
1400 LIVE OAK LN BLDG 100, WATKINSVILLE, GA 30677
(706) 395-5525
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA004694
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15168052
CAQH NUMBER
—
Enumeration date
06/15/2021
Last updated
01/10/2025
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