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General NPI Number Information
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NPI Number | 1699810424
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Entity Type | Individual
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Provider Name | ROBERT PEARSON
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 350 TOWN CENTER AVENUE SUITE 301
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City | SUWANEE
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State | GA
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Zip | 30024-9412
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Country | US
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Telephone | 678-835-0793
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Fax | 850-837-2042
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Provider Business Mailing Address
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Address Line | 350 TOWN CENTER AVENUE SUITE 301
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City | SUWANEE
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State | GA
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Zip | 30024
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Country | US
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Telephone | 678-835-0793
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Fax | 678-546-7932
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 8902
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License Number State | GA
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