Provider Demographics
NPI:1235190992
Name:PRIVETT, GEORGE W JR (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:PRIVETT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1725 HARRODSBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3601
Mailing Address - Country:US
Mailing Address - Phone:859-278-7226
Mailing Address - Fax:859-276-1540
Practice Address - Street 1:1725 HARRODSBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3601
Practice Address - Country:US
Practice Address - Phone:859-278-7226
Practice Address - Fax:859-276-1540
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2015-06-02
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Provider Licenses
StateLicense IDTaxonomies
KY149052085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048243OtherANTHEM BCBS
KY64149057Medicaid
KY611033603OtherHUMANA
KY611033603OtherHUMANA
KY000000048243OtherANTHEM BCBS
KY0040623Medicare PIN