Provider Demographics
NPI:1023185600
Name:PETTITT, BARBARA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JEAN
Last Name:PETTITT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1364 CLIFTON RD., NE
Mailing Address - Street 2:SURGICAL EDUCATION OFFICE ROOM H-121
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-727-1293
Mailing Address - Fax:404-712-0561
Practice Address - Street 1:1364 CLIFTON RD., NE
Practice Address - Street 2:SURGICAL EDUCATION OFFICE ROOM H-121
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-727-1293
Practice Address - Fax:404-712-0561
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2016-12-22
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Provider Licenses
StateLicense IDTaxonomies
GA27629174400000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA27629OtherGA LICENSE