Individual
MRS. ELIZABETH M PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 LANTANA RD, SUITE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(931) 484-5620
Mailing address
100 LANTANA RD, SUITE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(931) 484-5620
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD24627
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110074364
RAILROAD MEDICARE
—
01
—
164200
BLUE CROSS
TN
05
—
3076600
—
TN
Enumeration date
08/29/2006
Last updated
10/17/2023
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