Basic Information
| Provider Information | |||||||||
| NPI: | 1851482483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 VIRGINIA WAY | ||||||||
| Address2: | STE 300 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152214474 | ||||||||
| FaxNumber: | 6152343774 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 VIRGINIA WAY | ||||||||
| Address2: | STE 300 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152214474 | ||||||||
| FaxNumber: | 6152343774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 09/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 8783 | TN | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 22406 | KY | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 049632 | GA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 119455 | 01 | TN | UNISON TENNCARE | OTHER | 000923601A | 05 | GA | MEDICAID | 10054267 | 01 | GA | AMERIGROUP GA MEDICAIDCMO | OTHER | 200176420 | 05 | IN | MEDICAID | 3045385 | 01 | TN | BLUE CROSS | OTHER | 000923601D | 05 | GA | MEDICAID | 100025363 | 01 | TN | PHP TENNCARE | OTHER | 3069954 | 05 | TN | MEDICAID | 52802578004 | 01 | GA | BLUE CROSS | OTHER | 319817 | 01 | GA | WELLCARE MEDICAID GA CMO | OTHER | 89063HG | 05 | NC | MEDICAID | 000005002689 | 01 | TN | TLC TENNCARE | OTHER | 009989925 | 05 | AL | MEDICAID | 64777055 | 05 | KY | MEDICAID |