Provider Demographics
NPI:1548205727
Name:PEARSON, SAM SMISETH (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:SMISETH
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 HAZELWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167
Mailing Address - Country:US
Mailing Address - Phone:615-355-1338
Mailing Address - Fax:615-459-2851
Practice Address - Street 1:1332 HAZELWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-355-1338
Practice Address - Fax:615-459-2851
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17184207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4111360OtherBCBS TN #
TN3878540Medicare PIN
TNA98617Medicare UPIN
TN3878549Medicare PIN
TN3878547Medicare PIN
TN103I935831Medicare PIN
TN3878548Medicare PIN