Active NPI
John Alton Pettay, FNP C
- Family Nurse Practitioner
- Snellville, GA
National Provider Identifier
1902851645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN107083 NP
- Practice address
- 2295 Henry Clower Blvd
Suite 101
Snellville, GA 30078 - Phone
- (770) 972-4871
- Fax
- (770) 979-3782
- NPI assigned
- May 23, 2006
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN107083 NP | GA | Primary |
Addresses
Primary practice location
2295 Henry Clower Blvd
Suite 101
Snellville, GA 30078
Mailing address
1105 Pebble Bend Drive
Grayson, GA 30017
Phone (770) 985-2845
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN107083 NP | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John E. West, M.D., P.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Snellville, GA
- NPI 1124126420
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231804800000",
"number": "1902851645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 PEBBLE BEND DRIVE",
"city": "GRAYSON",
"state": "GA",
"postal_code": "30017",
"telephone_number": "770-985-2845",
"fax_number": "770-985-2845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2295 HENRY CLOWER BLVD",
"address_2": "SUITE 101",
"city": "SNELLVILLE",
"state": "GA",
"postal_code": "30078",
"telephone_number": "770-972-4871",
"fax_number": "770-979-3782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTAY",
"first_name": "JOHN",
"middle_name": "ALTON",
"name_prefix": "Mr.",
"credential": "FNP C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-23",
"last_updated": "2009-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN107083 NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Snellville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.