Free National NPI Number Registry
Jerry Miller Petty
Home > Jerry Miller Petty
NPI Number Detailed Information
Provider Information:
Name: | Jerry Miller Petty |
Gender: | M |
Provider License Number If Given: | 11925 |
NPI Information:
NPI: | 1124027628 |
Entity Type (Individual or Organization): |
1-ind |
Enumeration Date: | 7/18/2005 |
Last Update Date: | 10/23/2012 |
Provider Business Mailing Address:
Address: | 225 BALDWIN AVE Charlotte, NC 28204 |
Phone Number: | 7043761605 |
Fax Number: | 7043358448 |
Provider Business Practice Location Address:
Address: | 225 BALDWIN AVE Charlotte, NC 28204 |
Phone Number: | 7043761605 |
Fax Number: | 7043358448 |
Provider Taxonomy:
Primary: | 207T00000X |
Secondary (if any): | |
State: | NC |