NPIMap

Individual provider Active NPI

Marvel Pamela Wilson

  • Private Vehicle
  • Forest Park, GA
National Provider Identifier
1386062388
Registry record updated Apr 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Private VehicleTaxonomy code 347C00000X
License
347C00000X Issued in GA
Practice address
225 Johnson Rd Apt 38B
Forest Park, GA 30297-2892
Phone
(404) 437-8289
NPI assigned
Apr 7, 2014
Last updated
Apr 7, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Private Vehicle 347C00000X 347C00000X GA Primary

Addresses

Primary practice location

225 Johnson Rd Apt 38B
Forest Park, GA 30297-2892

Mailing address

225 Johnson Rd Apt 38B
Forest Park, GA 30297-2892
Phone (404) 437-8289

Other names 1

  • Marvel Pamela Soares Professional name

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

LicenseStateTypeSpecialty
347C00000XGAMDPrivate Vehicle

Practice roles

OrganizationSpecialtyStatusNew patients
Minwil Private Vehicle Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396828800000",
    "number": "1386062388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 JOHNSON RD APT 38B",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302972892",
            "telephone_number": "404-437-8289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 JOHNSON RD APT 38B",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302972892",
            "telephone_number": "404-437-8289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARVEL",
        "middle_name": "PAMELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-07",
        "last_updated": "2014-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "GA",
            "license": "347C00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARVEL",
            "last_name": "SOARES",
            "middle_name": "PAMELA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Forest Park, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.