MEDICARE: MITCHELL PEARCE

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	363A00000X	Physician Assistant	10519	GA

General Provider Information

NPI Number	:	1932875598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL PEARCE

Provider Business Mailing Address
First Line	:	2000 VIEW DR UNIT 2304
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5360
Country	:	US
Telephone Number	:	423-946-5824
Fax Number	:

Provider Business Practice Location Address
First Line	:	993 JOHNSON FY RD NE STE F210
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1688
Country	:	US
Telephone Number	:	404-256-1727
Fax Number	:	404-256-0192

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	12/14/2021

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Directions to “ MITCHELL PEARCE ” Practice Location

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