Healthcare Provider Details

I. General information

NPI: 1013190131
Provider Name (Legal Business Name): ALEJANDRO F. PERNETT, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HESTER ST
HAZLEHURST GA
31539-6323
US

IV. Provider business mailing address

9 HESTER ST
HAZLEHURST GA
31539-6323
US

V. Phone/Fax

Practice location:
  • Phone: 912-379-9380
  • Fax: 912-379-9382
Mailing address:
  • Phone: 912-379-9380
  • Fax: 912-379-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number029928
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number029928
License Number StateGA

VIII. Authorized Official

Name: DR. ALEJANDRO F PERNETT
Title or Position: OWNER
Credential: M.D.
Phone: 912-379-9380