P E T IMAGING OF FAYETTE LLC (NPI# 1619962503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1619962503 |
Entity Type | Organization |
Organization Name | P E T IMAGING OF FAYETTE LLC |
Other Organization Name | TRIDENT PET OF FAYETTE |
Practice Address |
1275 Highway 54 W Ste 102 Fayetteville GA 30214-4549 |
Mailing Address |
1275 Highway 54 W Ste 103 Fayetteville GA 30214-4549 |
Practice Telephone | 7707193754 |
Practice Fax Number | 7707193804 |
Mailing Telephone | 7706922371 |
Mailing Fax Number | 7706922373 |
Enumeration Date | 2005-09-16 |
Last Update Date | 2012-04-10 |
Authorized Official Name | GUY A MESSER (CFO) |
Authorized Official Telephone | 7706922371 |
Is Organization Subpart | Y |
Parent Organization Name | TRIDENT MOLECULAR IMAGING, LLC |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Trident PET of Fayette | Doing Business As Name - Organization |
Trident PET of Fayette | Doing Business As Name - Organization |
Street Address |
1275 HIGHWAY 54 W STE 102 |
City | FAYETTEVILLE |
State | GA |
Zip Code | 30214-4549 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952843013 | William Matthew Mowery | Physical Therapy Assistant | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2016-11-07 |
1013311224 | Drayton Thomas Perkins | Physical Therapist | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2014-10-17 |
1609283225 | Matthew Watson | Physical Therapist | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2014-07-15 |
1467888560 | Daniel John Voight | Physical Therapist | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2013-09-20 |
1881932010 | Georgia Urology Pa | Urology | 1275 Highway 54 W, Suite 205, Fayetteville, GA 30214-4549 | 2013-01-23 |
1457686917 | Aaron H Honeycutt | Physical Therapist | 1275 Highway 54 W, Suite 200, Fayetteville, GA 30214-4549 | 2009-10-16 |
1982838561 | Anthony Joseph Braim | Physical Therapist | 1275 Highway 54 W, Ste 200, Fayetteville, GA 30214-4549 | 2009-05-11 |
1447402086 | John W Sims | Nurse Practitioner | 1275 Highway 54 W, Suite 200, Fayetteville, GA 30214-4549 | 2008-10-15 |
1982877197 | Sleep Services of America | Clinical Medical Laboratory | 1275 Highway 54 W, Suite 203, Fayetteville, GA 30214-4549 | 2008-04-09 |
1801068754 | J. Rena Owsley-brown | Dentist | 1275 Highway 54 W, Suite 204, Fayetteville, GA 30214-4549 | 2008-04-01 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
Find all providers in zip 30214 |
Taxonomy Code | 2085R0202X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Radiology |
Specialization | Diagnostic Radiology |
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700211653 | Medical Associates of Northwest Arkansas Pa | Radiology | 3383 N Mana Ct Ste 102, Fayetteville, AR 72703-4965 | 2013-09-11 |
1831534346 | Kevin Tyler Goelz | Radiology | 605 Wentworth Ct, Fayetteville, GA 30215 | 2013-05-10 |
1689859829 | Santiago Miro | Radiology | 7302 Wakefield Dr, Fayetteville, NY 13066-9755 | 2008-01-07 |
1295858967 | Garney H Fendley | Radiology | 3215 N. North Hills Blvd, Fayetteville, AR 72703-4424 | 2007-04-09 |
1558424986 | Joseph Vincent Scrivani | Radiology | 5436 Springview Dr, Fayetteville, NY 13066-9678 | 2006-12-18 |
1538244751 | Bernard Schneider | Radiology | 7064 Woodchuck Hill Rd, Fayetteville, NY 13066-9764 | 2006-10-26 |
1023190097 | Andrew Bostaph | Radiology | 3027 Hampton Ridge Rd, Fayetteville, NC 28311-3005 | 2006-10-19 |
1326095639 | Cynthia Evette P Humphries | Radiology | 2053 Loganberry Dr, Fayetteville, NC 28304-0804 | 2006-05-30 |
1134170160 | Medical Associates of Northwest Arkansas Pa | Radiology | 55 W Sunbridge Dr, Fayetteville, AR 72703-1825 | 2006-05-15 |
1669430971 | Carolina Imaging LLC of Fayetteville | Radiology | 3628 Cape Center Dr, Fayetteville, NC 28304-4406 | 2006-05-03 |
Find all providers in FAYETTEVILLE |
City | FAYETTEVILLE |
Zip Code | 30214 |
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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.