GEORGE LYCURGLUS PETTY (NPI# 1831536333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831536333 |
| Entity Type | Individual |
| Full Name | GEORGE LYCURGLUS PETTY |
| Credential | M.D. |
| Practice Address |
1314 19th Ave Meridian MS 39301 |
| Mailing Address |
1901 5th Ave E Unit 1113 Tuscaloosa AL 35401-3868 |
| Practice Telephone | 2052709467 |
| Mailing Telephone | 2052709467 |
| Mailing Fax Number | 2053485294 |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2018-08-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 24118 | MS | Allopathic & Osteopathic Physicians |
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
MD.34536 | AL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 850 5th Ave E, Tuscaloosa, AL 354017419 | 2053481770 | 2053485294 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336356120 | George Emmett Petty IIi | Radiologic Technologist | 2155 E 23rd Ave S Ste A, Fremont, NE 68025-7849 | 2007-05-17 |
| 1831291624 | George Mcleod Petty Jr. | Psychologist | 301 Andrews Ave, Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2006-09-02 |
| 1255310934 | George W Petty | Psychiatry & Neurology | 200 1st St Sw, Rochester, MN 55905-0001 | 2006-01-11 |
| Street Address |
1314 19TH AVE |
| City | MERIDIAN |
| State | MS |
| Zip Code | 39301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780682807 | Teresa B. Redmond | Nurse Practitioner | 1314 19th Ave, Meridian, MS 39301-4116 | 2005-07-12 |
| 1881207918 | Cindy Renee' Quinn | Nurse Practitioner | 1314 19th Ave, Meridian, MS 39301-4195 | 2020-08-28 |
| 1821625773 | Michaela L. Moore | Nurse Practitioner | 1314 19th Ave, Meridian, MS 39301-4116 | 2020-03-23 |
| 1821631128 | Leah Lindsley Ward | Registered Nurse | 1314 19th Ave, Meridian, MS 39301-4116 | 2019-10-20 |
| 1356901169 | Laura Elizabeth Perry | Nurse Practitioner | 1314 19th Ave, Meridian, MS 39301-4116 | 2019-06-14 |
| 1407318231 | Stephen G Fleming | Registered Nurse | 1314 19th Ave, Meridian, MS 39301-4195 | 2019-04-01 |
| 1437624566 | Kayla Lauren Barnett | Nurse Practitioner | 1314 19th Ave, Meridian, MS 39301-4116 | 2018-10-04 |
| 1689158909 | Leah Denise Phillips | Nurse Practitioner | 1314 19th Ave, Meridian, MS 39301-4116 | 2018-09-21 |
| 1114401908 | Connie J Gainey | Nurse Practitioner | 1314 19th Ave, Meridian, MS 39301-4116 | 2018-09-18 |
| 1861988669 | Ashley Leigh Blass | Nurse Practitioner | 1314 19th Ave, Meridian, MS 39301-4116 | 2018-07-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407460439 | Kayla Lee Monsour | Pharmacist | 1415 24th Avenue, Meridian, MS 39301 | 2020-09-08 |
| 1306478359 | K&r Optical Solutions Corporation | Eyewear Supplier (Equipment, not the service) | 3126 8th St., Suite A, Meridian, MS 39301 | 2020-02-07 |
| 1912537317 | Courtney M Hollie | Counselor | 1054 Ms-19, Meridian, MS 39301 | 2020-01-24 |
| 1932636495 | Rcg Mississippi, Inc. | Clinic/Center | 1300 38th Ave E, Meridian, MS 39301 | 2017-05-16 |
| 1811428915 | Tierria Mcglothin | Nurse Practitioner | 1054 Highway 19 S, Meridian, MS 39301 | 2017-03-21 |
| 1154869303 | Lindsay Nemanich | Physical Therapist | 3716 Ms-39, Meridian, MS 39301 | 2017-02-08 |
| 1700323599 | Wal-mart Stores East Lp | Pharmacy | 3310-a Highway 39 North, Meridian, MS 39301 | 2017-01-31 |
| 1972977460 | Southeast Pharmacy LLC | Pharmacy | 2402 Long Creek Road, Meridian, MS 39301 | 2015-11-20 |
| 1235508342 | East Mississippi Oral & Facial Surgery, LLC | Clinic/Center | 1212 24th Avenue, Meridian, MS 39301 | 2015-09-18 |
| 1831580778 | Clarkdale Pharmacy and Gifts LLC | Pharmacy | 6935c Hwy 145, Meridian, MS 39301 | 2015-02-13 |
| Find all providers in zip 39301 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649736950 | The Free Clinic of Meridian, Inc. | Family Medicine | 4707 Poplar Springs Dr, Meridian, MS 39305-2622 | 2019-02-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588277206 | Sabrita R Hopkins | Family Medicine | 133 Rivergate Cv, Ridgeland, MS 39157-1039 | 2020-08-24 |
| 1629540646 | Homebridge Health, LLC | Family Medicine | 203 Remington Dr, Brandon, MS 39042-2829 | 2019-01-02 |
| 1578082137 | Kayla Anglin Moore | Family Medicine | 4381 S Eason Blvd Ste 202, Tupelo, MS 38801-6585 | 2017-09-14 |
| 1922186535 | David D Richardson | Family Medicine | 2659 Lakeland Dr Ste C, Flowood, MS 39232-9516 | 2006-11-01 |
| 1780610444 | Saloum Cisse | Family Medicine | 119 S Oak, Suite 2, Raymond, MS 39154-4205 | 2006-06-24 |
| 1821032392 | Rachel Antonia Jones | Family Medicine | 866 Medical Plz, Jackson, MS 39204-4948 | 2006-06-15 |
| 1831150531 | Harsh Doshi | Family Medicine | 17280 Highway 17 South, Lexington, MS 39095 | 2006-03-31 |
| 1922006279 | Virgil Isaac Aultman | Family Medicine | 2747 Old Canton Rd, Jackson, MS 39216-4308 | 2005-07-11 |
| 1184222374 | Kimyuana Jackson | Family Medicine | 20 Hobo Fork Rd, Natchez, MS 39120-9025 | 2020-10-11 |
| 1659993129 | Hawkins Family Medicine, Pllc | Family Medicine | 491a Craft St, Holly Springs, MS 38635-3251 | 2020-05-07 |
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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.