Provider Demographics
NPI:1295814432
Name:PETTIGREW, CARMELA AMELIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CARMELA
Middle Name:AMELIA
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13647
Mailing Address - Street 2:5311 PAULSEN STREET
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416
Mailing Address - Country:US
Mailing Address - Phone:912-355-7766
Mailing Address - Fax:912-352-7136
Practice Address - Street 1:5311 PAULSEN STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31416
Practice Address - Country:US
Practice Address - Phone:912-355-7766
Practice Address - Fax:912-352-7136
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA43109207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43109OtherLICENSE #
BP6271047OtherDEA
GA43109OtherLICENSE #
16DBTHXMedicare ID - Type Unspecified