Healthcare Provider Details

I. General information

NPI: 1124423611
Provider Name (Legal Business Name): SCOTT PEARSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL DR STE 707
LAGRANGE GA
30240-4130
US

IV. Provider business mailing address

300 MEDICAL DR STE 707
LAGRANGE GA
30240-4130
US

V. Phone/Fax

Practice location:
  • Phone: 706-803-7920
  • Fax: 770-999-2706
Mailing address:
  • Phone: 706-803-7920
  • Fax: 770-999-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11767
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11767
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1118529
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: