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Contact Information

SHANNA B PETTIE, MD
911 ELLIS AVE
JACKSON, MS39209-6256
 Phone: 601-533-7016
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Military Health Care Provider

171000000X
Indicates primary specialty

NPI Profile & details for SHANNA B PETTIE · (Female)

NPI # 1093978918
Status Active
Credentials MD
Entity Individual
Enumeration date 07/10/2008
Last updated 07/15/2025 - About 11 months ago
Sole proprietor 1 No
Identifiers
  • MS License # 23730
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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