Provider Demographics
NPI:1649262338
Name:PETTUS, WILLIAM H (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:PETTUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3810 CENTRAL PIKE STE 105
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3495
Mailing Address - Country:US
Mailing Address - Phone:615-649-6410
Mailing Address - Fax:615-329-5834
Practice Address - Street 1:3810 CENTRAL PIKE STE 105
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3495
Practice Address - Country:US
Practice Address - Phone:615-649-6410
Practice Address - Fax:800-319-2124
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2019-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN13685207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000975Medicaid
TNA96664Medicare UPIN
TN3000975Medicaid