MEDICARE: PEARL MAE ROSS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	216410	GA
2	363LF0000X	Family Nurse Practitioner	5020430	NC

General Provider Information

NPI Number	:	1366107872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARL MAE ROSS FNP

Provider Business Mailing Address
First Line	:	4797 SHAYE XING
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-3990
Country	:	US
Telephone Number	:	941-539-7906
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 FOREST HILLS RD W STE B
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3392
Country	:	US
Telephone Number	:	252-991-0555
Fax Number	:	252-991-0596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	02/03/2026

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