Provider Demographics
NPI:1629380753
Name:PEARSON, ERICH SMITH (MD)
Entity Type:Individual
Prefix:
First Name:ERICH
Middle Name:SMITH
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 INDUSTRIAL BLVD
Mailing Address - Street 2:P.O. BOX 1019
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3804
Mailing Address - Country:US
Mailing Address - Phone:706-276-4741
Mailing Address - Fax:706-276-4645
Practice Address - Street 1:822 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3804
Practice Address - Country:US
Practice Address - Phone:706-276-4741
Practice Address - Fax:706-276-4645
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA993428330AOtherMEDICAID RURAL HEALTH CARE PROVIDER NUMBER
GA1407062862OtherAPPLE MEDICAL CENTER GROUP NPI NUMBER
GAHOSP34OtherMEDICARE PART B NUMBER
GA58-1896463OtherNORTH GEORGIA MEDICAL CENTER FEDERAL TAX ID
GA1952395097OtherMEDICARE PART B NPI NUMBER
GA118518OtherAPPLE MEDICAL CENTER RURAL HEALTH MEDICARE PROVIDER NUMBER