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General NPI Number Information
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NPI Number | 1366760001
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Entity Type | Individual
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Provider Name | TIFFANY JONES PETTY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1801 DOCTORS DR
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City | SANFORD
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State | NC
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Zip | 27330-5067
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Country | US
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Telephone | 919-774-7117
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Fax | 919-776-6715
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Provider Business Mailing Address
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Address Line | 1801 DOCTORS DRIVE SANFORD PEDIATRICS, P.A.
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City | SANFORD
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State | NC
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Zip | 27330-5067
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Country | US
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Telephone | 919-774-7117
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Fax | 919-776-6715
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 32629
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2017-01510
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License Number State | NC
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