Healthcare Provider Details

I. General information

NPI: 1699762955
Provider Name (Legal Business Name): ROGER S PEARCE PAAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE ROAD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

PO BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-1745
  • Fax: 404-351-7121
Mailing address:
  • Phone: 800-243-3839
  • Fax: 954-839-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number3717
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: