Doctor Name: | MARY MERCEDES PETTIGNANO |
NPI Number: | 1063520237 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | A.A. |
License Number: | 002574 |
Business Practice Address: | 5730 Glenridge Suite 300 Atlanta, GA - 30328 |
Business Phone Number: | 4042501153 |
Business Fax Number: | |
Mailing Address: | 298 Buckhead Ave Ne, 1404 ATLANTA |
State: | GA |
Postal Code: | 303052672 |
Phone Number: | 4049830092 |
Fax Number: | |
NPI Enumeration Date: | 08/28/2006 |
NPI Last Update Date: | 09/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 002574 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |