Individual
MARY MERCEDES PETTIGNANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.A.
Contact information
Practice address
5730 GLENRIDGE, SUITE 300, ATLANTA, GA 30328
(404) 250-1153
Mailing address
298 BUCKHEAD AVE NE, 1404, ATLANTA, GA 30305-2672
(404) 983-0092
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
002574
GA
367H00000X
Anesthesiologist Assistant
Primary
002574
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
367H00000X
ANESTHETIST
GA
Enumeration date
08/28/2006
Last updated
09/24/2015
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