Healthcare Provider Details

I. General information

NPI: 1285486241
Provider Name (Legal Business Name): CONRAD PEARSON CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8066 WALNUT RUN RD STE 100
CORDOVA TN
38018-8842
US

IV. Provider business mailing address

8066 WALNUT RUN RD STE 100
CORDOVA TN
38018-8842
US

V. Phone/Fax

Practice location:
  • Phone: 901-252-3400
  • Fax:
Mailing address:
  • Phone: 901-252-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PAUL EBER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 901-252-3400