Individual
DR. PAUL M PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(318) 286-9787
Mailing address
4344 AUDUBON PARK LN, JACKSON, MS 39211-6142
(318) 286-9787
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21160
MS
207P00000X
Emergency Medicine Physician
N/A
LA
Other
Enumeration date
08/13/2007
Last updated
02/13/2012
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