Provider Demographics
NPI:1619996626
Name:GEORGE P PETTIT MD INC
Entity Type:Organization
Organization Name:GEORGE P PETTIT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-354-1434
Mailing Address - Street 1:1729 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-354-1434
Mailing Address - Fax:740-353-8811
Practice Address - Street 1:1729 27TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-354-1434
Practice Address - Fax:740-353-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0704830Medicaid
KY6593243600Medicaid
363LW0102XOtherARNP TAXONOMY CODE
KY7890083400Medicaid
KY6593243600Medicaid