Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 030527 | GA |
NPI | 1174532303 |
---|---|
Provider Name | Dr. Robert Pettignano |
First Address | Atlanta, GA 30303-3049 |
Second Address | Atlanta, GA 30303-3032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |