Jack G Pettigrew, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0644 Issued in TN

Practice address

514 W College St
Brownsville, TN 38012-3711

Phone

(731) 432-9461

Fax

(731) 772-6116

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1780798058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 W COLLEGE ST",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380123711",
            "telephone_number": "731-432-9461",
            "fax_number": "731-772-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 W COLLEGE ST",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380123711",
            "telephone_number": "731-432-9461",
            "fax_number": "731-772-6116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2290 N Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Brownsville",
            "state": "TN",
            "postal_code": "380121607",
            "country_code": "US",
            "telephone_number": "731-772-5183",
            "fax_number": "731-772-2781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTIGREW",
        "first_name": "JACK",
        "middle_name": "G",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "D0644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emmanuel I Obi, MD
• Brian Osborne
• Emily Outlaw, RN
• Torry O Patrick, PT
• Gary Dean Pettigrew, DPH
• Precious Stones Homes LLC
• Premier Dental Center
• Kaylee Prescott, RN
• L Allen Primrose, PHARMD
• Professional Home Health Care, LLC (CareAll Home Care Services, Inc.)

• Family Medicine Physician in Brownsville, TN
• Providers in Brownsville, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.