Active NPI
Albert M Petty, M.D.
- Radiation Oncology Physician
- Maryville, TN
National Provider Identifier
1881742641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 17745
- Practice address
- 907 E Lamar Alexander Pkwy
Radiation Therapy Department
Maryville, TN 37804-5015 - Phone
- (865) 977-5534
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 17745 | TN | Primary |
Addresses
Primary practice location
907 E Lamar Alexander Pkwy
Radiation Therapy Department
Maryville, TN 37804-5015
Mailing address
PO Box 1350
Powell, TN 37849-1350
Phone (865) 363-9248
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3037403 | Medicaid | TN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17745 | TN | MD | Radiation Oncology Physician |
Interoperability endpoints
- apetty@bmnet.direct.varian.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418774400000",
"number": "1881742641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1350",
"city": "POWELL",
"state": "TN",
"postal_code": "378491350",
"telephone_number": "865-363-9248",
"fax_number": "865-947-2960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "907 E LAMAR ALEXANDER PKWY",
"address_2": "RADIATION THERAPY DEPARTMENT",
"city": "MARYVILLE",
"state": "TN",
"postal_code": "378045015",
"telephone_number": "865-977-5534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "ALBERT",
"middle_name": "M",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2014-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "TN",
"license": "17745",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3037403",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maryville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.