Individual
DR. ERICKA M. RUSSELL PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3710 WATERS AVE, SAVANNAH, GA 31404-6209
(912) 777-5490
(912) 777-5491
Mailing address
5710 OGEECHEE RD, STE 200 BOX 283, SAVANNAH, GA 31405-9515
(912) 777-5490
(912) 777-5491
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
047258
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000880448C
—
GA
05
—
000880448D
—
GA
05
—
000880448E
—
GA
05
—
000880448H
—
GA
Enumeration date
10/28/2005
Last updated
08/13/2013
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