Provider Demographics
NPI:1366461162
Name:PEARSON, LAURA RIVERS (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:RIVERS
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MAE
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 HOSPITAL BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4919
Mailing Address - Country:US
Mailing Address - Phone:470-956-4270
Mailing Address - Fax:678-566-7803
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:678-393-0013
Practice Address - Fax:678-393-0310
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059950174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I025776Medicare UPIN