Provider Demographics
NPI:1467573857
Name:PETTES, CHRISTY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:LYNN
Last Name:PETTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LOWELL DR SE STE 1
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3738
Mailing Address - Country:US
Mailing Address - Phone:256-265-4462
Mailing Address - Fax:256-265-4463
Practice Address - Street 1:401 LOWELL DR SE STE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-265-4462
Practice Address - Fax:256-265-4463
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL37566207V00000X
TN044119207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL224025Medicaid
TN4232265OtherBCBSTN
TN1514163Medicaid