Provider Demographics
NPI:1730315367
Name:PEARSON, AMANDA DAVIDSON (AUD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAVIDSON
Last Name:PEARSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LORI
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:8001 CENTERVIEW PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4228
Mailing Address - Country:US
Mailing Address - Phone:901-755-5300
Mailing Address - Fax:901-753-9659
Practice Address - Street 1:7600 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1785
Practice Address - Country:US
Practice Address - Phone:901-755-5300
Practice Address - Fax:901-753-9659
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003924231H00000X
TNA1821231H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413650Medicaid
7512803OtherCIGNA
NC170A1OtherBCBSNC
NC9572652OtherAETNA
SCSAN098Medicaid
SC30118105OtherSELECT HEALTH
NC7413650Medicaid
SCQ388455874Medicare PIN