Healthcare Provider Details

I. General information

NPI: 1265912513
Provider Name (Legal Business Name): F CHRISTOPHER PETTIGREW MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD STE 501
POOLER GA
31322-4061
US

IV. Provider business mailing address

1000 TOWNE CENTER BLVD STE 501
POOLER GA
31322-4061
US

V. Phone/Fax

Practice location:
  • Phone: 912-988-1781
  • Fax: 912-777-7591
Mailing address:
  • Phone: 912-988-1781
  • Fax: 912-777-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number39904
License Number StateGA

VIII. Authorized Official

Name: FRANCIS CHRISTOPHER PETTIGREW
Title or Position: OWNER
Credential: MD
Phone: 912-988-1781