Individual
RONALD BRADBURN VINCENT PEARSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2855 OLD HIGHWAY 5 STE 108, BLUE RIDGE, GA 30513-6239
(706) 632-4217
(706) 632-4244
Mailing address
2855 OLD HIGHWAY 5 STE 108, BLUE RIDGE, GA 30513-6239
(706) 632-4217
(706) 632-4244
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
110203
GA
208600000X
Surgery Physician
20152
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001417002
MEDICAID GROUP
WV
01
—
5T5100381
MEDICARE GROUP
WV
05
—
7300262000
—
WV
01
—
BR5113081
MEDICARE PART B GROUP
WV
Enumeration date
05/19/2006
Last updated
11/17/2025
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