Healthcare Provider Details

I. General information

NPI: 1447298211
Provider Name (Legal Business Name): STEPHEN W PEARCE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 5TH ST SE
CAIRO GA
39828-3142
US

IV. Provider business mailing address

920 US HIGHWAY 84 W
THOMASVILLE GA
31792-0510
US

V. Phone/Fax

Practice location:
  • Phone: 229-377-0251
  • Fax: 229-377-7953
Mailing address:
  • Phone: 229-377-0251
  • Fax: 229-377-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN114248 CRNA
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: