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General NPI Number Information
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NPI Number | 1033175682
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Entity Type | Individual
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Provider Name | JAN H PETRI MD
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Gender | Female
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2028 W POPLAR AVE STE 112
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0618
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Country | US
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Telephone | 901-861-2526
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Fax | 901-861-2527
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Provider Business Mailing Address
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Address Line | 9554 FOX HILL CIR S
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City | GERMANTOWN
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State | TN
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Zip | 38139-6829
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Country | US
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Telephone | 901-861-2526
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Fax | 901-861-2527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 17612
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License Number State | TN
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