Provider Demographics
NPI:1467417105
Name:PIERSON, FARRELL D (MD)
Entity Type:Individual
Prefix:DR
First Name:FARRELL
Middle Name:D
Last Name:PIERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2330 SOUTHERN SHADE BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1686
Mailing Address - Country:US
Mailing Address - Phone:865-670-7675
Mailing Address - Fax:865-381-0442
Practice Address - Street 1:456 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4206
Practice Address - Country:US
Practice Address - Phone:931-484-6129
Practice Address - Fax:931-484-2685
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD30015207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN64721517Medicaid
TNG76550Medicare UPIN
TN64721517Medicaid