Active NPI
Pamela Kelson
- Driver
- Macon, GA
National Provider Identifier
1043349061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- Practice address
- 2575 Recreation Rd
Macon, GA 31217-5028 - Phone
- (478) 743-5688
- NPI assigned
- Mar 5, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | GA | Primary |
Addresses
Primary practice location
2575 Recreation Rd
Macon, GA 31217-5028
Mailing address
2575 Recreation Rd
Macon, GA 31217-5028
Phone (478) 743-5688
Other names 1
- Matang Michell Gibson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 255394772 | GA | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043349061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2575 RECREATION RD",
"city": "MACON",
"state": "GA",
"postal_code": "312175028",
"telephone_number": "478-743-5688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2575 RECREATION RD",
"city": "MACON",
"state": "GA",
"postal_code": "312175028",
"telephone_number": "478-743-5688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELSON",
"first_name": "PAMELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "GA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MATANG",
"last_name": "GIBSON",
"middle_name": "MICHELL",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.