Provider Demographics
NPI:1326357252
Name:PETTY ORTHOPAEDICS, PC
Entity Type:Organization
Organization Name:PETTY ORTHOPAEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:615-620-3260
Mailing Address - Street 1:2021 CHURCH ST STE 610
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2059
Mailing Address - Country:US
Mailing Address - Phone:615-620-3260
Mailing Address - Fax:615-620-3266
Practice Address - Street 1:2021 CHURCH ST
Practice Address - Street 2:SUITE 610
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2021
Practice Address - Country:US
Practice Address - Phone:615-620-3260
Practice Address - Fax:615-620-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732245Medicaid
TN3732245Medicare PIN
TN5684990001Medicare NSC