Individual
DR. JANINE NICOLE PETTIFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
325 NORTH JEFF DAVIS DR, FAYETTEVILLE, GA 30214
(770) 461-1337
(770) 461-0922
Mailing address
33 UPPER RIVERDALE ROAD SW, SUITE 112, FAYETTEVILLE, GA 30214-1627
(770) 996-3190
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
072414
GA
208600000X
Surgery Physician
2010013505
MO
208600000X
Surgery Physician
BP10023659
TX
Other
Enumeration date
01/20/2010
Last updated
11/08/2016
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