MEDICARE: ROBYN ALLEN PETAGREW DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	052671	GA
2	207R00000X	Internal Medicine Physician	052671	GA

General Provider Information

NPI Number	:	1144303280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN ALLEN PETAGREW DO

Provider Business Mailing Address
First Line	:	7259 S BINGHAM JUNCTION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-4860
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 CASCADE PKWY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-3090
Country	:	US
Telephone Number	:	801-930-3751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	12/13/2021

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