Provider Demographics
NPI:1427133974
Name:PETTIS, PAMELA COBB (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:COBB
Last Name:PETTIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-7103
Mailing Address - Country:US
Mailing Address - Phone:704-446-9991
Mailing Address - Fax:704-446-0854
Practice Address - Street 1:251 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7103
Practice Address - Country:US
Practice Address - Phone:704-446-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400023207V00000X
NC2004-00023207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137T4OtherBCBS
NC89137T4Medicaid
SCN00021Medicaid
NC2038694BMedicare PIN
NC137T4OtherBCBS
NC89137T4Medicaid