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Individual

GLENDA V PETTAWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
215 N COLEMAN ST, SWAINSBORO, GA 30401-3530
(478) 237-2638
(478) 237-9138
Mailing address
215 N COLEMAN ST, SWAINSBORO, GA 30401-3530
(478) 237-2638
(478) 237-9138

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
062456
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000632376I
GA
05
269902777A
GA
Enumeration date
08/17/2009
Last updated
02/22/2012
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