Provider Demographics
NPI:1164456075
Name:PIERCE, JOHN BLAIR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BLAIR
Last Name:PIERCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GWENDOLYN AVE
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1433
Mailing Address - Country:US
Mailing Address - Phone:648-237-1413
Mailing Address - Fax:678-840-2112
Practice Address - Street 1:2117 DR GEORGE WARD RD
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-5971
Practice Address - Country:US
Practice Address - Phone:706-283-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP024458A225200000X
SC669225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant