=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366400913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE H PEARSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2006
-----------------------------------------------------
Last Update Date | 12/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 N LAFAYETTE ST
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-484-0464
-----------------------------------------------------
Fax | 704-482-0308
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 959 COX RD
-----------------------------------------------------
City | GASTONIA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28054-3420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-866-7576
-----------------------------------------------------
Fax | 704-866-7576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 24327
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------