Provider Demographics
NPI:1851332274
Name:PEARSON, DONNA W (PA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:W
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 GUNBARREL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3127
Mailing Address - Country:US
Mailing Address - Phone:423-756-6623
Mailing Address - Fax:423-648-8084
Practice Address - Street 1:1736 GUNBARREL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3127
Practice Address - Country:US
Practice Address - Phone:423-756-6623
Practice Address - Fax:423-648-8084
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000941363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3661929Medicaid
TN3661929Medicare PIN
TNP94972Medicare UPIN