Provider Demographics
NPI:1851482483
Name:PIERCE, EDGAR H JR (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:H
Last Name:PIERCE
Suffix:JR
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 1:5301 VIRGINIA WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7541
Mailing Address - Country:US
Mailing Address - Phone:615-221-4474
Mailing Address - Fax:615-234-3774
Practice Address - Street 1:5301 VIRGINIA WAY
Practice Address - Street 2:STE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7541
Practice Address - Country:US
Practice Address - Phone:615-221-4474
Practice Address - Fax:615-234-3774
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8783207ZP0102X
KY22406207ZP0102X
GA049632207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN119455OtherUNISON TENNCARE
GA000923601AMedicaid
GA10054267OtherAMERIGROUP GA MEDICAIDCMO
IN200176420Medicaid
TN3045385OtherBLUE CROSS
GA000923601DMedicaid
TN100025363OtherPHP TENNCARE
TN3069954Medicaid
GA52802578004OtherBLUE CROSS
GA319817OtherWELLCARE MEDICAID GA CMO
NC89063HGMedicaid
TN000005002689OtherTLC TENNCARE
AL009989925Medicaid
KY64777055Medicaid
GA22BDDJDMedicare ID - Type Unspecified
GA000923601AMedicaid
IN200176420Medicaid
GA52802578004OtherBLUE CROSS
TN100025363OtherPHP TENNCARE