Provider Demographics
NPI:1932875598
Name:PEARCE, MITCHELL
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:PEARCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VIEW DR UNIT 2304
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5360
Mailing Address - Country:US
Mailing Address - Phone:423-946-5824
Mailing Address - Fax:
Practice Address - Street 1:993 JOHNSON FY RD NE STE F210
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1688
Practice Address - Country:US
Practice Address - Phone:404-256-1727
Practice Address - Fax:404-256-0192
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant