Individual
MATTHEW J PETRILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1314 UNIVERSITY AVE, SEWANEE, TN 37375-2303
(931) 598-5648
(931) 598-0778
Mailing address
PO BOX 700, SEWANEE, TN 37375-0700
(931) 598-5648
(931) 598-0778
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
000713
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063817625
GROUP NPI
TN
Enumeration date
01/25/2006
Last updated
03/09/2015
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