Jerry Miller Petty
Neurosurgeon
225 Baldwin Ave
Charlotte
, North Carolina 28204-3109
Jerry Miller Petty
Neurosurgeon
225 Baldwin Ave
Charlotte
, North Carolina 28204-3109
(704) 335-8448
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About
Features
Specialties
- Neurosurgeon
Languages spoken
- English
Location
First Address
- Jerry Miller Petty
- 225 Baldwin Ave
- Charlotte, NC
- Zip : 28204-3109
- Fax : (704) 335-8448
- Phone : (704) 376-1605
Second Address
- Jerry Miller Petty
- 225 Baldwin Ave
- Charlotte, NC
- Zip : 28204-3109
- Fax : (704) 335-8448
- Phone : (704) 376-1605
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207T00000X | Neurosurgeon | 11925 | NC |
National Provider Identifier
| NPI | 1124027628 |
|---|---|
| Provider Name | Jerry Miller Petty |
| First Address | Charlotte, NC 28204-3109 |
| Second Address | Charlotte, NC 28204-3109 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/07/2005 |
| Last Update Date | 14/12/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 140004695 | RAILROAD MEDICARE (01) | |
| 453681 | (05) | SC |
| 8967385 | (05) | NC |
| C85972 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.