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Individual

DR. SHANNA B PETTIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
911 ELLIS AVE, JACKSON, MS 39209-6256
(601) 533-7016
Mailing address
PO BOX 746085, ATLANTA, GA 30374-6085
(773) 352-1515

Taxonomy

Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
207R00000X
Internal Medicine Physician
Primary
23730
MS

Other

Enumeration date
07/10/2008
Last updated
07/15/2025
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