Provider Demographics
NPI:1780025809
Name:PEARSON, BILLY (NP)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 281030
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1030
Mailing Address - Country:US
Mailing Address - Phone:904-482-1070
Mailing Address - Fax:904-482-1077
Practice Address - Street 1:1560 SUMRALL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2654
Practice Address - Country:US
Practice Address - Phone:601-736-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner