P E T IMAGING OF FAYETTE LLC NPI 1619962503

NPI Information

NPI: 1619962503
Provider Name: P E T IMAGING OF FAYETTE LLC

Doing Business As: TRIDENT PET OF FAYETTE

Classification: Radiology - 2085R0202X
Entity Type: Organization

Specialization: Diagnostic Radiology

Address:
1275 HIGHWAY 54 W
STE 102
FAYETTEVILLE, GA
ZIP 30214
Phone: (770) 719-3754
Get Directions

P E T IMAGING OF FAYETTE LLC is a diagnostic radiology radiology in Fayetteville, GA. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. P E T IMAGING OF FAYETTE LLC NPI is 1619962503. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Trident Pet Of Fayette.

The provider's business location address is:

1275 HIGHWAY 54 W
STE 102
FAYETTEVILLE, GA
ZIP 30214-549
Phone: (770) 719-3754
Fax: (770) 719-3804

The provider's authorized official is Guy A Messer .
The authorized official title is Cfo and has the following contact phone number (770) 692-2371.

The enumeration date for this NPI number is 9/16/2005 and was last updated on 4/10/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	47BBBJJ	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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