Provider Demographics
NPI:1366107872
Name:ROSS, PEARL MAE (FNP)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:MAE
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4797 SHAYE XING
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-3990
Mailing Address - Country:US
Mailing Address - Phone:941-539-7906
Mailing Address - Fax:
Practice Address - Street 1:2503 FOREST HILLS RD W STE B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3392
Practice Address - Country:US
Practice Address - Phone:252-991-0555
Practice Address - Fax:252-991-0596
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2024-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA216410363LF0000X
NC5020430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily