Provider Demographics
NPI:1821526229
Name:PIERSON, JOHNATHAN TRENT (MD)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:TRENT
Last Name:PIERSON
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 1:601 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4519
Mailing Address - Country:US
Mailing Address - Phone:912-662-0088
Mailing Address - Fax:912-527-6072
Practice Address - Street 1:601 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4519
Practice Address - Country:US
Practice Address - Phone:912-662-0088
Practice Address - Fax:912-527-6072
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0109066A2084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty