Organization
ZANDRA RENEE PETWAY MD,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ZANDRA R PETWAY M.D., (OWNER)
(615) 884-0215
Entity
Organization
Contact information
Practice address
457 DONELSON PIKE, NASHVILLE, TN 37214-3561
(615) 884-0215
Mailing address
PO BOX 2018, BRENTWOOD, TN 37024-2018
(615) 884-0215
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
27699
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3802977
—
TN
01
—
4010427
BLUECROSS BLUESHIELD
TN
Enumeration date
04/22/2008
Last updated
04/22/2008
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