Provider Demographics
NPI:1063466803
Name:PEARSON, RONALD BRADBURN VINCENT JR (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:BRADBURN VINCENT
Last Name:PEARSON
Suffix:JR
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 1:2855 OLD HIGHWAY 5 STE 108
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6239
Mailing Address - Country:US
Mailing Address - Phone:706-632-4217
Mailing Address - Fax:706-632-4244
Practice Address - Street 1:2855 OLD HIGHWAY 5 STE 108
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6239
Practice Address - Country:US
Practice Address - Phone:706-632-4217
Practice Address - Fax:706-632-4244
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110203208600000X
WV20152208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVBR5113081OtherMEDICARE PART B GROUP
WV0001417002OtherMEDICAID GROUP
WV5T5100381OtherMEDICARE GROUP
WV7300262000Medicaid
WVBR5113081OtherMEDICARE PART B GROUP