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General NPI Number Information
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NPI Number | 1669646576
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Entity Type | Organization
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Legal Business Name | ZANDRA RENEE PETWAY MD,PC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 457 DONELSON PIKE
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City | NASHVILLE
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State | TN
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Zip | 37214-3561
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Country | US
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Telephone | 615-884-0215
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2018
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City | BRENTWOOD
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State | TN
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Zip | 37024-2018
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Country | US
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Telephone | 615-884-0215
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ZANDRA R PETWAY
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Credential | M.D.,
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Telephone | 615-884-0215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 27699
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License Number State | TN
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