Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 17827 | TN |
NPI | 1003897141 |
---|---|
Provider Name | Cathy E Petty |
First Address | Chattanooga, TN 37422-4776 |
Second Address | Maryville, TN 37804-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 02/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3027925 | (05) | TN |
3028647 | BLUE CROSS BLUE SHIELD TN (01) | TN |
A99176 | (02) | TN |