Individual
DR. CHARLES WILLIAM PETTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1267 HIGHWAY 54 W, STE 2200, FAYETTEVILLE, GA 30214-2114
(770) 716-0051
(770) 716-0087
Mailing address
20 FRANCIS WAY, SUITE 101, SHARPSBURG, GA 30277
(770) 253-0611
(770) 502-0521
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
033675
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000650413NOQ
—
GA
Enumeration date
06/15/2005
Last updated
09/13/2010
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