Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 000623 | GA |
NPI | 1013911817 |
---|---|
Provider Name | Dr. William Kevin Pearson |
First Address | Peachtree City, GA 30269-4794 |
Second Address | Peachtree City, GA 30269-4794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 03/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00455661F | (05) | GA |
202I487652 | MEDICARE PTAN (01) | GA |
U19596 | (02) |