MEDICARE: ALLISON PETSCHKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	97000	SC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1568152791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON PETSCHKE MD

Provider Business Mailing Address
First Line	:	2200 CHILDRENS WAY
Second Line	:	8232 DOCTORS OFFICE TOWER (DOT)
City	:	NASHVILLE
State	:	TN
Zip	:	37232-9760
Country	:	US
Telephone Number	:	615-936-2555
Fax Number	:	615-936-3601

Provider Business Practice Location Address
First Line	:	2067 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5834
Country	:	US
Telephone Number	:	843-573-2535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	06/24/2026

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