Petty, Jerry Miller

Petty, Jerry Miller is an individual health care provider with primary practice located at 225 Baldwin Ave , Charlotte NC 28204-3109. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurological Surgery, which is considered as his primary health care specialty. Petty, Jerry Miller can be contacted via phone (704) 376-1605.

Contact Information

Primary practice address
225 Baldwin Ave Charlotte NC 28204-3109
Phone: (704) 376-1605
Fax: (704) 335-8448
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X 11925 North Carolina

Profile Details

NPI number 1124027628
LBN Legal business name Petty, Jerry Miller
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2005
Last updated Dec 14th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124027628 NPPES
Other 140004695 RAILROAD MEDICARE
MEDICAID 453681 RAILROAD MEDICARE
MEDICAID 8967385 RAILROAD MEDICARE

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