Healthcare Provider Details

I. General information

NPI: 1992758882
Provider Name (Legal Business Name): CONRAD PEARSON CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WOLF PARK DR STE 102
GERMANTOWN TN
38138-1759
US

IV. Provider business mailing address

1325 WOLF PARK DR STE 103
GERMANTOWN TN
38138-1759
US

V. Phone/Fax

Practice location:
  • Phone: 901-252-3400
  • Fax: 901-682-0047
Mailing address:
  • Phone: 901-252-3411
  • Fax: 901-384-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL ANDREW GRANIERI
Title or Position: PRESIDENT
Credential: MD
Phone: 901-252-3400