Provider Demographics
NPI:1104900406
Name:PHELPS, PAMELIA J (PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELIA
Middle Name:J
Last Name:PHELPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 COLLEGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1737
Mailing Address - Country:US
Mailing Address - Phone:706-213-8506
Mailing Address - Fax:706-213-0335
Practice Address - Street 1:114 COLLEGE AVE
Practice Address - Street 2:STE C
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1737
Practice Address - Country:US
Practice Address - Phone:706-213-8506
Practice Address - Fax:706-213-0335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65-PCBGVMedicare ID - Type UnspecifiedOUTPATIENT PT CLINIC