Provider Demographics
NPI:1285865667
Name:PETIT, JOSEPH C (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:PETIT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5676
Mailing Address - Country:US
Mailing Address - Phone:865-988-9970
Mailing Address - Fax:865-271-6621
Practice Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR
Practice Address - Street 2:STE 200
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5676
Practice Address - Country:US
Practice Address - Phone:865-988-9970
Practice Address - Fax:865-271-6621
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2020-06-24
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Provider Licenses
StateLicense IDTaxonomies
TN53452207RC0000X
CAA120890207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ016720Medicaid