Healthcare Provider Details

I. General information

NPI: 1811801616
Provider Name (Legal Business Name): JOHANN PECSON PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 BEAM RD
CHARLOTTE NC
28217-9422
US

IV. Provider business mailing address

11954 E OLD US HIGHWAY 64
LEXINGTON NC
27292-7336
US

V. Phone/Fax

Practice location:
  • Phone: 619-746-3937
  • Fax:
Mailing address:
  • Phone: 619-746-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146E00000X
TaxonomyCommunity Paramedic
License NumberP122960
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: