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Individual

DR. LAQUETTA NICOL PETTWAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2250 BESSEMER RD STE 200, BIRMINGHAM, AL 35208-4725
(205) 382-8265
(205) 382-8215
Mailing address
601 S HARBOUR ISLAND BLVD STE 200, TAMPA, FL 33602-5925
(727) 322-3439
(800) 928-7449

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.19390
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
051119644
BCBS
AL
01
1376588095
TRICARE SOUTH
AL
Enumeration date
06/17/2006
Last updated
12/01/2025
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