Individual
SHALONDA B PETTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(404) 367-3014
(404) 367-3558
Mailing address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(404) 367-3014
(404) 367-3558
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004248
GA
Other
Enumeration date
01/02/2007
Last updated
04/11/2016
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