Provider Demographics
NPI:1336356120
Name:PETTY, GEORGE EMMETT III (ARRT (R) (M) (CT))
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EMMETT
Last Name:PETTY
Suffix:III
Gender:M
Credentials:ARRT (R) (M) (CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-5231
Mailing Address - Country:US
Mailing Address - Phone:931-623-0979
Mailing Address - Fax:
Practice Address - Street 1:2155 E 23RD AVE S STE A
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7849
Practice Address - Country:US
Practice Address - Phone:866-784-2329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01200046232471C3401X, 2471M1202X
TN53812471C3401X, 2471M1202X
OHR88582802471C3401X, 2471M1202X
NY3639232471C3401X, 2471M1202X
NJ6393102471C3401X, 2471M1202X
MDR00079302471C3401X, 2471M1202X
KY10-121-140152471C3401X
CARHF 771852471C3401X
DE53022471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging