Provider Demographics
NPI:1730416736
Name:PETTY, MADELINE ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:ELLIOTT
Last Name:PETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:CLAIRE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5 SANDY POINT RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-1105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 SANDY POINT RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-1105
Practice Address - Country:US
Practice Address - Phone:912-521-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081218207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology