Healthcare Provider Details

I. General information

NPI: 1023847688
Provider Name (Legal Business Name): LINDSEY PETTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-3085
US

IV. Provider business mailing address

403 VICTORIA CIR
WARNER ROBINS GA
31088-3085
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-9558
  • Fax:
Mailing address:
  • Phone: 478-225-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA283306
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: