Active NPI
Demetria Pettaway
- Medical Technologist
- Mobile, AL
National Provider Identifier
1750734752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Technologist
- Practice address
- 1903 Spring Hill Ave
Mobile, AL 36607-2303 - Phone
- (251) 295-5110
- Fax
- (251) 545-4963
- NPI assigned
- Jul 14, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | Primary |
Addresses
Primary practice location
1903 Spring Hill Ave
Mobile, AL 36607-2303
Mailing address
1903 Spring Hill Ave
Mobile, AL 36607-2303
Phone (251) 295-5110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468454400000",
"number": "1750734752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1903 SPRING HILL AVE",
"city": "MOBILE",
"state": "AL",
"postal_code": "366072303",
"telephone_number": "251-295-5110",
"fax_number": "251-545-4963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1903 SPRING HILL AVE",
"city": "MOBILE",
"state": "AL",
"postal_code": "366072303",
"telephone_number": "251-295-5110",
"fax_number": "251-545-4963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTAWAY",
"first_name": "DEMETRIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-14",
"last_updated": "2016-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "246QM0706X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Pathology, Medical Technologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mobile, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.