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General NPI Number Information
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NPI Number | 1063520237
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Entity Type | Individual
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Provider Name | MARY MERCEDES PETTIGNANO A.A.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 5730 GLENRIDGE SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30328
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Country | US
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Telephone | 404-250-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 298 BUCKHEAD AVE NE 1404
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City | ATLANTA
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State | GA
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Zip | 30305-2672
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Country | US
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Telephone | 404-983-0092
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002574
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 002574
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License Number State | GA
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