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NPI Code Detail

MEDICARE: MR. PATRICK LEE PEARSON JR. CSFA

MEDICARE: MR. PATRICK LEE PEARSON JR. CSFA
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
1246ZC0007XSurgical Assistant
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1508601675
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PATRICK LEE PEARSON JR. CSFA
Provider Business Mailing Address
First Line : 316 MADDI GRACE CT
Second Line :
City : LOCUST GROVE
State : GA
Zip : 30248-9801
Country : US
Telephone Number : 678-464-6326
Fax Number : 678-823-6937
Provider Business Practice Location Address
First Line : 316 MADDI GRACE CT
Second Line :
City : LOCUST GROVE
State : GA
Zip : 30248-9801
Country : US
Telephone Number : 678-464-6326
Fax Number : 678-823-6937
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2024
Last Update Date : 04/06/2026

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