DR. SHANNA B PETTIE (NPI# 1093978918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093978918 |
| Entity Type | Individual |
| Full Name | DR. SHANNA B PETTIE |
| Credential | M.D. |
| Practice Address |
106 Lake Vista Pl Brandon MS 39047-6384 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6019192924 |
| Practice Fax Number | 6019927347 |
| Mailing Telephone | 6012004749 |
| Mailing Fax Number | 6012005929 |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2019-09-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 23730 | MS | Allopathic & Osteopathic Physicians |
| N | 171000000X | Military Health Care Provider | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 971 Lakeland Dr, Suite 250, Jackson, MS 392164643 | 6012004860 | 6012004887 |
| Street Address |
106 LAKE VISTA PL |
| City | BRANDON |
| State | MS |
| Zip Code | 39047-6384 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467937029 | Mea Primary Care Plus, LLC | Family Medicine | 106 Lake Vista Pl, Brandon, MS 39047-6384 | 2018-09-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396368783 | Siyuan Chen Kennedy | Counselor | 108 Sandstone Drive, Brandon, MS 39047 | 2020-05-20 |
| 1568019784 | Juarez Brown Emerson | Registered Nurse | 426 Pinebrook Circle, Brandon, MS 39047 | 2019-08-22 |
| 1649764127 | Specialty Diagnostics LLC | Family Medicine | 1149 Old Fannin Rd Ste 22, Brandon, MS 39047 | 2018-06-19 |
| 1528423035 | Kathlene Strangeman | Social Worker | 111 Lakeshore Dr Apt G403, Brandon, MS 39047 | 2015-12-28 |
| 1174935076 | Anthony Davis | Counselor | 198 Bellegrove Cir, Brandon, MS 39047 | 2014-05-27 |
| 1144659178 | Medical Foundation of Central Ms, Inc | Family Medicine | 1887 Spillway Rd., Brandon, MS 39047 | 2013-11-12 |
| 1437429941 | Picton Timothy Evans | Pharmacist | 150 B Cumberland Ed, Brandon, MS 39047 | 2012-01-01 |
| 1275828030 | Kathryn Audell Piburn | Nurse Practitioner | 1887 Spillway Rd Ste 140, Brandon, MS 39047 | 2011-06-09 |
| 1801930532 | Susanne Reynolds Moore | Dentist | 1149 Old Fannin Rd, Suite 26, Brandon, MS 39047 | 2007-02-16 |
| 1194898429 | Brookshire Grocery Company | Durable Medical Equipment & Medical Supplies | 143 Plaza Drive Ext, Attention Pharmacy Dept, Brandon, MS 39047 | 2006-11-16 |
| Find all providers in zip 39047 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043723752 | Advanced Adult Medicine, Inc | Internal Medicine | 1127 Nikki View Dr, Brandon, FL 33511-4879 | 2017-11-16 |
| 1235411000 | Brandon-riverview Medical | Internal Medicine | 519 E Bloomingdale Ave Ste A, Brandon, FL 33511-8180 | 2011-09-16 |
| 1518119726 | James A Plemmons | Internal Medicine | 615 Vonderburg Dr., Brandon, FL 33511 | 2008-10-21 |
| 1326203977 | Meditech Medical Centers, LLC | Internal Medicine | 1783 S. Kings Ave., Brandon, FL 33511-6220 | 2008-07-23 |
| 1326207382 | Ron Mathew | Internal Medicine | 500 Vonderburg Dr Ste 215w, Brandon, FL 33511-5977 | 2008-06-05 |
| 1780888248 | Parsons Medical Center Inc | Internal Medicine | 908 S Parsons Ave, Suite A, Brandon, FL 33511-6064 | 2007-06-11 |
| 1639397904 | Todd Lee Gracen | Internal Medicine | 1209 Lakeside Dr, Brandon, FL 33510-4109 | 2007-04-23 |
| 1518011386 | Express Care of Tampa Bay, Inc | Internal Medicine | 107 W Robertson St, Brandon, FL 33511-5111 | 2007-01-22 |
| 1932250131 | Care Plus Walk In Clinics | Internal Medicine | 519a E Bloomingdale Ave, Brandon, FL 33511-8105 | 2007-01-15 |
| 1760552673 | Anurag Reddy Kumbham | Internal Medicine | 500 Vonderburg Dr 102e, Cornerstone Medical Care of Brandon, Brandon, FL 33511 | 2006-11-08 |
| Find all providers in BRANDON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.