Provider Demographics
NPI:1427044650
Name:PETTIGREW, FRANCIS CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:CHRISTOPHER
Last Name:PETTIGREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TOWNE CENTER BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4061
Mailing Address - Country:US
Mailing Address - Phone:912-988-1781
Mailing Address - Fax:912-777-7591
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 501
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4061
Practice Address - Country:US
Practice Address - Phone:912-988-1781
Practice Address - Fax:912-777-7591
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39904208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00663715AMedicaid
GA240005770OtherRAILROAD MEDICARE
24BCBLGMedicare PIN
E57556Medicare UPIN
SC148058Medicaid