Provider Demographics
NPI:1184683179
Name:PETTY ORTHOPAEDICS PC
Entity Type:Organization
Organization Name:PETTY ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:H
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-443-7374
Mailing Address - Street 1:1616 W MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3101
Mailing Address - Country:US
Mailing Address - Phone:615-443-7374
Mailing Address - Fax:615-443-5488
Practice Address - Street 1:1616 W. MAIN ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-443-7374
Practice Address - Fax:615-443-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732245Medicaid
TN1861452195OtherMEDICARE NPI
TN3732245OtherMEDICARE PTAN
TN1861452195OtherMEDICARE NPI