James Pemberton, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA004694 Issued in GA

Practice address

1400 Live Oak LN BLDG 100
Watkinsville, GA 30677

Phone

(706) 395-5525

Fax

(706) 546-8792

NPI assigned

Jun 15, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1801464946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 LIVE OAK LN BLDG 100",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "30677",
            "telephone_number": "706-395-5525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 LIVE OAK LN BLDG 100",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "30677",
            "telephone_number": "706-395-5525",
            "fax_number": "706-546-8792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEMBERTON",
        "first_name": "JAMES",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-15",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH NUMBER",
            "identifier": "15168052",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Payne, PT, DPT
• Jeffrey David Pearce, MD
• Daniel Pelletier
• Pemberton & Associates
• Gregory A Pemberton, RPT AND OTR
• Julio Ernesto Pena, M.D.
• Amanda Peterson, RBT
• Sabrina Peterson, PHARM D
• Dee William Pettigrew III, M.D.
• Kaitlyn Pfannkuche, LCSW

• Physical Therapy Assistant in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; 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.