Provider Demographics
NPI:1750376208
Name:PET IMAGING CENTER OF SAVANNAH LLC
Entity type:Organization
Organization Name:PET IMAGING CENTER OF SAVANNAH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-692-1387
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-0249
Mailing Address - Country:US
Mailing Address - Phone:770-692-1387
Mailing Address - Fax:770-692-2373
Practice Address - Street 1:617 STEPHENSON AVE
Practice Address - Street 2:STE 101
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5838
Practice Address - Country:US
Practice Address - Phone:912-355-7523
Practice Address - Fax:912-355-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA617511716BMedicaid
47BBBKPMedicare ID - Type Unspecified