Provider Demographics
NPI:1871563403
Name:PEARLSTEIN, JONATHAN J (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:J
Last Name:PEARLSTEIN
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 1:3850 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-8667
Mailing Address - Country:US
Mailing Address - Phone:706-253-1401
Mailing Address - Fax:706-253-1405
Practice Address - Street 1:3850 CAMP RD
Practice Address - Street 2:SUITE C
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-8667
Practice Address - Country:US
Practice Address - Phone:706-253-1401
Practice Address - Fax:706-253-1405
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0459102084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00804955CMedicaid
GAG87523Medicare UPIN
GA00804955CMedicaid