MEDICARE: DR. SONJA PETTUS M.D.

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	207R00000X	Internal Medicine Physician	27916	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184769424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONJA PETTUS M.D.

Provider Business Mailing Address
First Line	:	1450 JONES DAIRY RD
Second Line	:	BLDG 600
City	:	JASPER
State	:	AL
Zip	:	35501-6106
Country	:	US
Telephone Number	:	205-295-4200
Fax Number	:	205-295-4201

Provider Business Practice Location Address
First Line	:	1450 JONES DAIRY RD
Second Line	:	BLDG 700
City	:	JASPER
State	:	AL
Zip	:	35501-6106
Country	:	US
Telephone Number	:	205-295-4200
Fax Number	:	205-295-4201

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	09/28/2007

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