Healthcare Provider Details

I. General information

NPI: 1174532303
Provider Name (Legal Business Name): ROBERT PETTIGNANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JESSE HILL JR DR SE
ATLANTA GA
30303-3032
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE ROOM 282
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4390
  • Fax:
Mailing address:
  • Phone: 404-778-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number030527
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: