Healthcare Provider Details

I. General information

NPI: 1740196229
Provider Name (Legal Business Name): RAMON LORENZO PEARSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 ARLINGTON MEADOWS DR APT 1A
JACKSONVILLE NC
28546-5754
US

IV. Provider business mailing address

1032 ARLINGTON MEADOWS DR APT 1A
JACKSONVILLE NC
28546-5754
US

V. Phone/Fax

Practice location:
  • Phone: 912-509-1595
  • Fax:
Mailing address:
  • Phone: 912-509-1595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number4389620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: