Provider Demographics
NPI:1982481677
Name:GILCHRIST, PAMELA RAE (LMT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RAE
Last Name:GILCHRIST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:RAE
Other - Last Name:GILCHRIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:5050 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1719
Mailing Address - Country:US
Mailing Address - Phone:706-224-1872
Mailing Address - Fax:
Practice Address - Street 1:5050 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1719
Practice Address - Country:US
Practice Address - Phone:706-224-1872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist